• 


' 

. 
; 


STAFF 


BLOOMINCTON,  1ND. 

MATEEIA    MEDICA 


AND 


THERAPEUTICS^ 


INORGANIC     SUBSTANCES 


BY 


CHARLES   D.   F.  PHILLIPS,   M.D. 

MEMBER  OF  THE  ROYAL  COLLEGE   OF  PHYSICIANS,    ETC.  ;   LATE  LECTURER  ON  MATEBIA  MEDICA  AND 
THERAPEUTICS  AT  THE  WESTMINSTER  HOSPITAL  MEDICAL  SCHOOL 


(gftiteb  anfo  QUmpteft  to  tljc  U.  Q.  }3ljarmac0pccia 

BY 


LAUEENCE   JOHNSON,  A.M.,  M.D. 

LECTURER  ON  MEDICAL  BOTANY,  MEDICAL  DEPARTMENT  OF  THE   UNIVERSITY  OF  THE  CITY  OF  NEW  YORK  ; 
FELLOW  OF  THE  NEW  YORE  ACADEMY  OF  MEDICINE,  ETC. 


VOLUME    I. 


NEW  YORK 
WILLIAM    WOOD    &    COMPANY 

1882 


0  ^  J  J  0  0 


COPTBIQHT 

WILLIAM   WOOD  &  COMPANY 

1882 


TROW'S 

PRINTING  AND  BOOKBINDING  COMPANY 

201-213  East  Twelfth  Street 

NEW  YORK 


$0 

JOHN  EEIC  EKICHSEN,   F.R.S. 

EX-PRESIDENT  OF  THE  ROYAL  COLLEGE  OF  SURGEONS  OF  ENGLAND,  SURGEON 
EXTRAORDINARY  TO  HER  MAJESTY  THE  QUEEN 

iG  Book  is  Dcbicatcb 


EXPRESSION  OF  ESTEEM  FOR  HIS  PROFESSIONAL  ABILITY 


GRATITUDE  FOR  MUCH  PERSONAL  KINDNESS 


,9  a 


I/. 


PUBLISHERS'   PREFACE. 


THE  first  part  of  Dr.  Phillips's  "  Materia  Medica  and  Therapeu- 
tics " — the  "  Vegetable  Kingdom  "—edited  by  Dr.  Piffard,  was  pub- 
lished in  "Wood's  Library  of  Standard  Medical  Authors  in  1879. 

T~ 

This,  the  concluding  part,  has  but  just  been  completed  by  the 
•i  author,  and  is  adapted  to  the  United  States  Pharmacopeia,  for  this 
^    series,  by  Dr.  Laurence  Johnson.     The  author's  text  is  presented  en- 
/}  tire ;  all  additions  are  included  in  brackets. 


*> 


PREFACE. 


THIS  volume  is  published  in  succession  to  one  upon  the  Vegetable 
Kingdom,  and  is  arranged  upon  a  similar  plan.  Several  of  our  best 
modern  treatises  upon  the  same  subjects  completely  separate  pharma- 
cology from  therapeutics,  but  it  has  seemed  to  me  better  to  recom- 
mend their  simultaneous  study,  and  I  have  devoted  more  space  than 
is  now  usual  to  pharmaceutical  chemistry ;  this  will  be  to  the  advan- 
tage, I  am  sure,  of  the  student,  and  I  trust,  of  the  practitioner.  That 
ample  space  should  be  given  to  discussing  the  physiological  action  of 
medicines  is  a  necessary  condition  of  any  modern  work,  and  if  the 
conclusions  reached,  and  the  bearings  of  facts  gathered  under  this 
head,  are  still  rather  vague  and  undefined,  they  at  least  engage  and 
deserve  earnest  attention,  and  point  to  the  direction  in  which  further 
advance  may  be  made. 

My  former  volume  was  published  in  1874,  and  as  some  explana- 
tion of  the  long  interval  between  it  and  the  present  one,  I  may  say 
that  in  1877  I  had  commenced  arrangements  with  the  printer  when  a 
serious  railway  accident  interrupted  my  work,  and  incapacitated  me 
for  any  exertion  for  upward  of  two  years ;  the  conditions  under  which 
I  have  now  completed  the  book  may  perhaps  be  accepted  as  some 
apology  for  its  defects. 

During  the  interval,  several  excellent  treatises  on  the  same  sub- 
jects have  been  published,  and  I  have  to  acknowledge  many  obliga- 
tions to  those  of  Dr.  H.  C.  Wood,  Jr.,  Dr.  Bartholow,  Dr.  Garrod, 
Dr.  Ringer,  as  well  as  to  the  works  of  Trousseau,  Stille,  Husemann, 
Nothnagel,  Kohler,  Gubler,  and  Kabuteau.  I  am  also  indebted  to 
the  "  Poisons "  of  Dr.  Taylor,  the  "  Therapeutics  "  of  Dr.  Waring, 


Vlll  PREFACE. 

the  "  Commentary "  of  Dr.  W.  G.  Smith,  the  "  Handbook;  "  of  Dr. 
Fothergill,  the  "  Companion "  of  Squire,  and  the  "  Chemistry "  of 
Miller:  the  latter  I  have  mainly  followed  as  to  mercury,  iron,  and 
other  important  drugs,  but  it  is  possible  that  some  discrepancies  may 
still  be  found  between  older  and  more  modern  chemical  formulae. 

The  "Medical  Digest"  of  Dr.  !Neale  I  have  found  exceedingly 
useful.  Various  important  monographs,  e.g.,  those  of  Preyer,  Binz, 
liebreich,  Frazer,  Brunton,  and  others,  and  valuable  papers  in  various 
journals  will  be  found  quoted  in  their  proper  place. 

The  abbreviations  and  references  will,  I  believe,  be  found  suffi- 
ciently full  for  easy  recognition.  The  British  and  Foreign  Medico- 
Chwurgical  Review  is  quoted  either  as  Brit,  and  For.  Rev.  or  as 
Med.-Chir.  Rev.  j  the  Edinburgh  Journal  of  Medicine  as  Edin. 
Journ. ;  the  American  Journal  of.  the  Medical  Sciences  as  Amer. 
Journ.  or  Amw.  Rev.  ;  Practitioner  refers  to  the  London  journal  of 
that  name,  unless  otherwise  specified ;  Dub.  Quart,  or  Dub.  Journ. 
to  the  Dublin  Journal  of  Medical  Science. 

Finally,  I  have  to  thank  Dr.  Mackey,  Dr.  Menzies  of  Cannes,  Dr. 
Port,  and  Mr.  A.  Pearce  Gould,  for  their  valuable  assistance  in  look- 
ing up  references  and  aiding  me  with  many  suggestions  and  correc- 
tions while  the  work  was  passing  through  the  press. 

2  GBOSVENOR  SQUARE,  LONDON,  W., 
December  1,  1881. 


CONTENTS  OF  VOL.  I. 


OXYGEN— OZONE— COMPRESSED  AIR 1-14 

Physiological  Action,  External,  2  ;  Internal,  2-8 ;    Therapeutical  Action,  8  ; 
Mode  of  Administration,  14. 

NITROGEN 15 

HYDROGEN 16 

Peroxide  of,  16. 

CARBO — CHARCOAL 18-20 

Therapeutical  Action,  External,  19  ;  Internal,  19,  20 ;  Preparations  and 
Dose,  20. 

SULPHUR 21 

SULPHIDES  OR  SULPHURETS 22-34 

Absorption  and  Elimination,  22  ;  Physiological  Action,  External,  23  ;  In- 
ternal, 23,  24 ;  Therapeutical  Action,  External,  24 ;  Internal,  28 ;  Prep- 
arations and  Doses,  33 ;  Adulterations,  34. 

PHOSPHORUS 35-57 

Absorption  and  Elimination,  36  ;  Physiological  Action,  External,  36 ;  In- 
ternal, 37 ;  Toxic  Action,  40 ;  Tolerance,  41  ;  Theory  of  Action,  42 ; 
Antidotes,  44 ;  Therapeutical  Action,  Internal,  45  ;  Preparations  and 
Dose,  57. 

IODUM— IODINE.  . .  58-59 


X  CONTENTS. 

PAGE 

COMPOUNDS  OF  IODINE — IODOFORM 59-94 

Absorption  and  Elimination,  60 ;  Physiological  Action,  External,  62  ;  In- 
ternal, 62 ;  Idiosyncrasy — Toleration.  68  ;  Incompatibles,  69  ;  Therapeu- 
tical Action,  External,  70  ;  Internal,  82  ;  Preparations  and  Dose,  93. 

BROMUM — BROMINE 94-97 

Physiological  Action,  95  ;  Therapeutical  Action,  External,  98  ;  Internal, 
97. 

COMPOUNDS  OP  BROMINE 97-120 

Absorption  and  Elimination,  98  ;  Physiological  Action,  Internal,  99 ; 
"  Bromism,"  100  ;  Therapeutical  Action,  External,  104  ;  Internal,  105  ; 
Preparations  and  Dose,  119. 

CHLORUM — CHLORINE 120-124 

Absorption  and  Elimination,  121  ;  Physiological  Action,  External,  121  ; 
Internal,  122  ;  Therapeutical  Action,  External,  123;  Internal,  124  ;  Prep-  . 
arations  and  Dose,  124. 

AQUA— WATER 125-150 

Absorption  and  Elimination,  125  ;  Physiological  Action,  External  (Forms 
of  Bath),  125  ;  Internal,  135  ;  Therapeutical  Action,  External,  136 ;  In- 
ternal, 119. 

SEA-BATHING 150-153 

Physiological  Action,  151  ;  Therapeutical  Action,  152  ;  Errors  in,  152, 
153. 

MINERAL  WATERS  AND  BATHS 153-180 

Physiological  and  Therapeutical  Action,  153,  154;  Classification,  154, 

ACIDUM  ACETICUM — ACETIC  ACID — GLACIAL  ACETIC  ACID 180 

ACIDUM  ACETICUM  DILUTUM — VINEGAR 180-184 

Absorption  and  Elimination,  181  ;  Physiological  Action,  181  ;  Prepara- 
tions and  Do'se,  183. 

ACIDUM  CARBONICUM — CARBONIC  ACID 184-189 

Absorption  and  Elimination,  184 ;  Physiological  Action,  185  ;  Therapeu- 
tical Action,  187. 


CONTENTS.  XI 

PAGE 

ACIDUM  ClTRICUM — ClTRIC  ACID 189-191 

Absorption  and  Elimination,  190  ;  Physiological  Action,  190 ;  Therapeu- 
tical Action,  190 ;  Preparations  and  Dose,  191. 

ACIDUM  HTDBOCHLORICUM— HYDROCHLORIC  ACID 191-199 

Absorption  and  Elimination,  192  ;  Physiological  Action,  192  ;  Toxic  Ac- 
tion, 195 ;  Therapeutical  Action,  External,  196 ;  Internal,  196 ;  Prepara- 
tions and  Dose,  199. 

ACIDUM    NITRO-HYDROCHLORICUM    DILUTUM  —  DILUTE    NITRO-HYDRO- 

CHLORIC  ACID 199-201 

Physiological  and  Therapeutical  Action,  200 ;  Preparations  and  Dose, 
201 ;  Bath,  201. 

A.CIDUM  HYDROCYANICUM  DILUTUM — DILUTED  HYDROCYANIC  ACID 202-215 

Absorption  and  Elimination,  203  ;  Physiological  Action — Toxic  Action, 
204  ;  Theory  of  Action,  209  ;  Antidotes,  210  ;  Therapeutical  Action,  Ex- 
ternal, 211  ;  Internal,  212  ;  Preparations  and  Dose,  214. 

ACIDUM  NITRICUM — NITRIC  ACID 215-221 

Absorption  and  Elimination,  216  ;  Physiological  Action,  216  ;  Therapeu- 
tical Action,  External,  217  ;  Internal,  219  ;  Preparations  and  Dose,  221. 

ACIDUM  PHOSPHORICUM  DILUTUM— DILUTE  PHOSPHORIC  ACID 221-227 

Absorption  and  Elimination,  222  ;  Physiological  Action,  222  ;  Therapeu- 
tical Action,  224 ;  Preparation  and  Dose,  227. 

ACIDUM  SULPHURICUM — SULPHURIC  ACID 227-233 

Absorption  and  Elimination,  227  ;  Physiological  Action,  228  ;  Therapeu- 
tical Action,  External,  230 ;  Internal,  231 ;  Preparations  and  Dose,  233. 

ACIDUM  SULPHUROSUM— SULPHUROUS  ACID 233-247 

ALKALINE  SULPHITES  AND  HYPOSULPHITES 234-247 

Absorption  and  Elimination,  235  ;  Physiological  Action,  External  (Disin- 
fection), 235 ;  Internal,  236  ;  Therapeutical  Action,  External,  237  ;  In- 
ternal, 243  ;  Preparations  and  Dose,  247. 


Xll  CONTENTS. 

PAGE 

ACIDUM  TARTABICUM— TARTARIC  ACID 247-249 

Absorption  and  Elimination,  248  ;  Physiological  Action,  248  ;  Therapeu- 
tical Action,  249  ;  Preparation  and  Dose,  249. 

AMMONIUM — AMMONIA  GAS 249-250 

COMPOUNDS  OF  AMMONIA 250-264 

Absorption  and  Elimination,  252;  Physiological  Action,  253;  Therapeu- 
tical Action,  External,  257 ;  Internal,  259 ;  Preparations  and  Dose,  263. 

ALUMINUM — ALUM. 265-266 

COMPOUNDS  OF  ALUMINA 266-275 

Absorption  and  Elimination,  266 ;  Physiological  Action,  266  ;  Theory  of 
Action,  268 ;  Therapeutical  Action,  External,  268 ;  Internal,  271 ;  Prep- 
arations and  Dose,  275. 

ANTIMONIUM — ANTIMONY  AND  COMPOUNDS 275-298 

Absorption  and  Elimination,  278 ;  Physiological  Action,  External,  279 ; 
Internal,  279  ;  Theory  of  Action,  285  ;  Tolerance,  286  ;  Antidotes,  286 ; 
Therapeutical  Action,  External,  287  ;  Internal,  287  ;  Preparations  and 
Dose,  297. 


MATERIA    MEDICA 


AND 


THERAPEUTICS. 


SUBSTANCES. 


OXYGEN,  0,= 16— OZONE,  Os. 

OXYGEN  is  the  most  universally  diffused  element,  forming  part  of  the 
air,  the  water,  the  earth,  and  of  the  tissues  of  plants  and  animals.  Of 
the  air  it  constitutes  23.01  per  cent,  by  weight,  20.81  per  cent,  by  meas- 
ure, being  about  one-fifth  part.  By  Priestley,  who  discovered  it  (in  1774), 
it  was  named  "  dephlogisticated  or  vital  air." 

Ozone  is  an  allotropic  form  of  oxygen.  Its  discoverer,  Schonbein, 
did  not  arrive  at  a  knowledge  of  its  real  nature,  but  Odling  (in  1860),  by 
a  "  splendid  hypothesis,"  concluded  it  to  be  a  condensed  condition  of 
oxygen,  and  this  was  afterward  verified,  among  other  observers,  by  Bro- 
die,  who  adopted  the  symbol  O3,  implying  that  three  atoms  of  oxygen  are 
condensed  in  each  one  of  ozone.  A  minute  proportion  of  it  is  found  in 
the  atmosphere — more  in  that  of  the  open  country  and  of  the  sea  than  in 
that  of  towns,  but  its  precise  distribution  and  variation  are  not  yet  ascer- 
tained. Richardson  calculated  its  amount  as  1  in  10,000  of  air  ("Brit- 
ish Association  Report,"  3865). 

PBEPARATIOTST. — Oxygen  may  be  obtained  pure  from  most  of  its  com- 
binations, but  is  conveniently  and  usually  prepared  by  heating  the  per- 
oxide of  manganese,  or  the  chlorate  of  potash,  or  both  together.  The 
former  yields  about  one-ninth  of  its  weight  of  oxygen.  3MnO,=MnO, 
Mn,O3  +  2O;  or  2KC1O3=2KC1+3O2. 

Ozone  is  produced  in  small  quantities  during  the  slow  oxidation  of 
phosphorus  and  some  other  substances.  Lender  recommends  for  its  evo- 
VOL.  I.— 1 


2  MATERIA    MEDICA    AND    THERAPEUTICS. 

lution  in  sick  chambers  a  mixture  of  peroxide  of  manganese,  permanga- 
nate of  potash,  and  oxalic  acid,  to  be  dissolved  in  water.  In  the  labora- 
tory it  is  prepared  by  passing  a  succession  of  electric  sparks  through  a 
closed  chamber  filled  with  air. 

CHARACTERS  AND  TESTS. — The  principal  characteristic  of  oxygen  is 
its  energetic  power  of  combination  with  organic  principles,  and  with  min- 
erals, to  form  acids  and  salts  (oxidation),  and  with  hydrogen  to  form 
water.  It  is  a  gas  devoid  of  color,  odor,  or  taste,  of  sp.  gr.  1.1057  (at- 
mospheric air  being  taken  as  1).  Under  a  pressure  of  320  atmospheres, 
and  at  a  temperature  of  — 220°  F.,  it  has  been  -liquefied  by  Pictet  (1877). 

Ozone  is  much  denser  than  oxygen,  and  in  most  chemical  and  physical, 
though  not  in  all  vital  effects,  it  is  more  active;  it  is  further  distin- 
guished by  a  peculiar  odor;  also  it  is  a  powerful  oxidizing  agent,  and 
changes  many  protosalts  into  persalts;  it  displaces  iodine  from  some  of 
its  combinations,  hence  iodized  starch  paper  is  used  as  a  test  for  the  gas 
— the  paper  turns  bluish  as  iodine  is  set  free,  and  combines  with  the 
starch,  but  the  test  is  not  very  dependable.  Ozone  is  absorbed  by  tur- 
pentine. 

According  to  Paul  Bert,  it  possesses  marked  antiseptic  properties, 
and  animal  substances  keep  long  unputrefied  in  an  atmosphere  to  which 
a  minute  proportion  of  ozone  has  been  added  (Medical  Record,  1876; 
Comptes  Jtendus,  t.  80). 

PHYSIOLOGICAL  ACTION  (EXTERNAL). — Th,e  external  and  local  action 
of  oxygen  in  contact  with  mucous  membrane  or  denuded  skin  is  moder- 
ately stimulating. 

PHYSIOLOGICAL  ACTION  (INTERNAL). — To  describe  fully  the  physiolo- 
gical action  of  oxygen  would  involve  a  description  of  the  processes  of 
respiration,  sanguification,  nutrition,  and  tissue-change,  for  to  all  these, 
and  to  life  itself,  it  is  essential.  If  it  be  deficient  in  the  respired  air,  or 
if  it  be  insufficiently  absorbed,  all  the  functions  become  disordered,  assim- 
ilation is  impeded,  circulation  diminished,  and  temperature  lowered,  and 
if  its  access  to  the  lungs  be  prevented  for  a  few  minutes,  life  altogether 
ceases.  But  we  are  concerned,  at  present,  only  with  the  results  of  certain 
experiments  in  which  animals  or  men  have  been  made  to  respire  either 
pure  oxygen,  or  an  atmosphere  artificially  charged  with  a  definite  pro- 
portion of  the  gas,  and  the  first  question  that  arises  is  whether  more  than 
a  normal  amount  of  oxygen  can  be  taken  into  the  blood  under  such  cir- 
cumstances. 

It  was  early  proved  that  animals  kept  under  a  bell-jar  filled  with  oxy- 
gen lived  longer  than  in  ordinary  air;  and  also  that  animals  made  to 
breathe  oxygen  could  resist  asphyxia  longer  than  similar  animals  that 
had  breathed  only  air  (Priestley,  Beddoes),  but  Regnault  and  Reiset, 
while  corroborating  the  former  observation,  concluded,  from  a  series  of 
experiments,  that  breathing  an  atmosphere  rich  in  oxygen,  or  even  one  of 


OXYGEN.  3 

the  pure  gas,  did  not  make  the  blood  take  up  more  oxygen  than  it  would 
from  ordinary  air,  nor  was  more  carbonic  acid  excreted  in  consequence 
(Annales  de  Chimie,  1844).  But  these  conclusions,  which  had  much  in- 
fluence on  professional  opinion  at  the  time,  have  been  disproved.  Preyer 
showed  that  a  greater  saturation  from  oxygen-inhalation  is,  &  priori,  prob- 
able, and  that  ordinary  arterial  blood  is  not  fully  saturated  with  oxygen 
• — that  it  can  take  up  more  by  being  shaken  with  the  gas.  Demarquay 
proved  it  by  showing  that  suppurating,  indolent,  or  unhealthy  wounds 
on  the  extremities  of  animals  became  quickly  florid  and  hyperasmic  when 
pure  oxygen  was  inhaled;  .an  extra  amount  of  the  stimulating  gas  must 
clearly  have  been  carried  by  the  circulation  to  the  wound.  Allen  and 
Pepys,  and  later,  Limousin,  showed,  by  inhaling  an  equal  quantity  of  at- 
mospheric air  at  one  time,  and  of  oxygen  at  another,  that,  after  the  lat- 
ter, double  the  amount  of  carbonic  acid  was  expired,  and  this  increase 
continued  fifteen  minutes  after  the  inhalation  had  finished.  Other  ob- 
servers have  reported  that  the  elimination  of  uric  acid  during  a  course  of 
oxygen-inhalation  is  markedly  lessened,  i.e.,  that  more  complete  combus- 
tion occurs  within  the  system  (Schmidt's  Jahrb.,  1865,  t.  1,  s.  28);  thus, 
Kollmann  found  that  while  300  grammes  of  the  ordinary  secretion  of 
urine  contained  236  milligrammes  of  acid,  the  same  quantity  contained 
only  122  milligrammes  after  inhalation  of  12  litres  of  oxygen.  On  an- 
other occasion  the  amount  of  acid  came  down  from  134  milligrammes  to 
25  milligrammes. 

A  clinical  illustration,  pointing  in  the  same  direction,  is  given  by 
Gubler.  After  several  copious  draughts  of  the  pure  gas  in  an  active  nas- 
cent condition,  the  respiratory  movements  and  the  pulse  became  slower, 
a  general  sense  of  comfort  was  felt,  and,  without  any  dyspnoea,  the  pause 
between  expiration  and  inspiration  could  be  much  prolonged.  Thus,  tak- 
ing thirty  seconds  as  a  maximum  time  during  which  the  breath  may  be 
"  held  "  after  breathing  atmospheric  air,  it  rises  to  ninety  to  one  hundred 
seconds  after  breathing  oxygen.  From  other  observations,  Gubler  con- 
cludes that  the  blood  receives  the  gas  in  proportion  to  its  physical  capa- 
city for  it,  rather  than  in  proportion  merely  to  the  vital  necessity  of  hae- 
matosis:  the  globules  absorb  what  they  need,  while  any  excess  circulates 
free,  and  enters  into  combination  only  as  the  haemoglobulin  loses  oxygen 
in  passing  through  the  capillaries.  Hence,  the  amount  of  oxygen  absorbed 
by  an  individual  is  proportionate  to  the  number  of  his  corpuscles  (we 
should  now  say  of  his  haemoglobin),  and  a  plethoric  man  quickly  using 
up  his  reserve  air  breathes  faster  than  a  healthy  one.  On  the  other  hand, 
an  anaemic  patient  also  breathes  more  rapidly  than  normal,  since  his  cor- 
puscles are  either  too  few  in  number  or  otherwise  altered,  so  that  they 
cannot  take  up  enough  oxygen.1  Buchheim  states  an  opposite  view,  viz., 

1  "  Quinquaud,  availing  himself  of  the  reducing  properties  of  sodic  hydrosulphite, 
was  enabled  to  calculate  the  maximum,  quantity  of  oxygen  capable  of  being  absorbed 


4  MATERIA    MEDICA    AND    THERAPEUTICS. 

that  oxygen  is  not  absorbed  proportionally  to  the  amount  of  it  brought  to 
the  lungs,  but  to  its  requirement  for  tissue-change;  yet  even  he  admits 
that  the  amount  taken  in  can  be  increased  to  some  extent  by  continued 
deep  inspirations,  and  by  breathing  air  rich  in  oxygen  or  under  high  pres- 
sure; he  only  denies  that  such  adventitious  oxygen  affects  the  tissue- 
change  (Archiv  fur  Exper.  Pathologic:  Klebs,  Bd.  iv.,  1875);  he  admits 
also  that  improvement  in  symptoms  may  result  from  breathing  compressed 
air  or  pure  oxygen,  but  thinks  we  cannot  hope  to  influence  the  course  of 
illness  by  increasing  the  amount  of  oxygen  contained  in  the  blood. 

Granting,  then,  the  possibility  of  taking  into  the  blood  more  than 
the  normal  amount  of  the  gas,  it  yet  remains  true  that  in  many  healthy 
persons  no  marked  effect  is  to  be  noted  from  inhalations  of  fifteen  to  thirty 
litres  of  oxygen,  unless  it  be  a  sense  of  warmth  in  the  mouth  and  at  the 
epigastrium  (Husemann). 

Naoumoff  and  Beliaieff,  breathing  it  for  seven  to  seventeen  minutes, 
found  no  appreciable  change  in  pulse  or  temperature,  whilst  in  dogs  made 
to  breathe  alternately  air  and  oxygen,  the  temperature  rose  sometimes 
with  the  latter  a  few  tenths  of  a  degree,  and  there  seemed  some  dilatation 
of  capillaries  (Abstract,  Lancet,  i.,  1875). 

Mr.  Savory,  partly  following  Regnault  and  Reiset,  and  partly  relying 
upon  observations  with  animals  which  showed  no  increase  of  temperature 
under  oxygen-inhalations,  has  also  argued  that  these  can  exert  no  effect 
on  the  system;  but  Dr.  Edward  Smith  has  pointed  out  that  such  ex- 
periments, to  be  conclusive,  should  extend  over  long  periods,  and  take 
account  of  changes  in  diet,  etc.;  he  himself  found  evidence  of  increased 
chemical  change  under  oxygen. 

In  some  persons,  inhalation  of  the  gas  causes  temporary  nerve-symp- 
toms, such  as  exhilaration,  sense  of  vigor,  heat  of  skin,  tingling  of  fingers, 
and  even  pain  referred  to  the  fifth  nerve  (Husemann).  I  have  myself 
observed  all  these  symptoms,  except  the  last,  immediately  after  the  in- 
halation; also  some  giddiness,  and  some  rise  of  pulse,  probably  from  extra 
effort  in  breathing;  in  the  delicate,  improved  appetite,  improved  motor 
power,  and  sleep  have  followed.  I  can  corroborate  this  observation, 
which  has  been  made  by  Birch,  Demarquay,  and  others.  Oxygen,  then, 
is  not  without  effects,  though  these  vary  with  different  individuals,  and 
we  cannot  yet  reduce  them  to  precise  scientific  expression. 

Dr.  Richardson,  judging  partly  from  a  case  in  which  the  blood  passed 
from  the  lungs  back  to  the  right  heart,  and  so  circulated  "surcharged 
with  oxygen,"  states  that  such  excess  leads  to  great  exhaustion  of  mus- 

by  a  given  amount  of  blood.  The  mean  capacity  in  health,  he  found,  was  240  cubic 
centimetres  of  oxygen  to  every  1,000  grammes  of  blood=:128  grammes  haemoglobin." 
He  assumes  that  this  absorption  capacity  is  invariable,  but  in  reality  it  varies  accor*d- 
ing  to  illness,  especially  in  forms  of  anaemia.  (Coupland  :  Gulstonian  Lectures, 
March,  1881). 


OXYGEN.  5 

cular  and  nerve-power  and  constant  perspiration  (Lancet,  ii.,  1878),  but 
the  conditions  are  not  simple  enough  for  asserting  that  these  symptoms 
are  solely  due  to  the  gas.  If  an  animal  be  kept  in  a  closed  vessel  full  of 
oxygen,  it  dies — we  cannot  exactly  say  why.  Broughton  discovered  that 
rabbits,  guinea-pigs,  sparrows,  etc.,  thus  kept,  were  at  first  lively  and  ex- 
cited with  quickened  circulation  and  respiration,  but  passed  in  an  hour's 
time  into  a  weakly,  depressed  condition,  and  finally  died,  although  the  air 
in  the  bell-jar  was  still  pure  enough  to  rekindle  a  flame.  Dr.  Richardson 
obtained  similar  results  with  oxygen  that  had  been  breathed  and  then 
purified,  and  he  inferred  that  some  principle  essential  to  life  yvas  removed 
from  the  gas  in  the  process  of  respiration  (British  Medical  Journal,  ii., 
1860).  He  found  in  the  animals  after  death  a  condition  of  "  hyperinosis," 
and  Demarquay,  who  met  with  analogous  results,  describes  the  volume  of 
the  blood  as  apparently  much  increased,  the  muscular  and  other  tissues 
brightly  red,  the  venous  blood  distinctly  to  be  recognized,  but  less  dark 
than  usual,  and  more  quickly  reddened  on  exposure,  the  lungs  congested 
being  "  intensely  red,"  and  all  the  viscera  unduly  vascular.  The  same 
observer  states  that  a  small  amount  of  gas  may  be  passed  directly  into 
the  blood  by  careful  intravenous  injection,  and  in  such  cases,  after  death, 
the  spleen  is  markedly  redder  than  usual. 

Theory  of  Action. — Rosenthal  concluded  from  certain  experiments 
that  an  increased  amount  of  oxygen  in  the  blood  caused  "  apncea,"  for  if, 
after  blowing  in  air  for  twenty  to  sixty  minutes  through  the  trachea  of 
an  animal,  the  artificial  respiration  be  suddenly  interrupted,  the  animal 
remains  motionless  and  without  breathing  for  twenty  to  forty  seconds, 
then  respiratory  action,  at  first  weak,  ultimately  normal,  returns.  Now, 
this  being  an  opposite  condition  to  one  of  dyspnoea,  and  the  latter  being 
dependent  upon  want  of  oxygen  and  consequent  extra  stimulus  of  the 
respiratory  centre,  he  argued  that  apncea  must  depend  on  overmuch 
oxygen.  Ewald  also,  by  experiment,  determined  some  slight  increase  of 
oxygen  in  the  blood  in  apnoea;  Hering  not  so.  In  any  case  there  is  really 
no  causal  relation  between  the  two  facts  (Buchheim:  loc.  cit.),  nor  is 
apnosa  complained  of  after  oxygen-inhalation  or  condensed  air  treatment. 

Experiments  of  this  nature,  though  very  interesting,  cannot  be  taken 
as  practical  guides  in  the  clinical  use  of  the  gas,  and,  under  ordinary  con- 
ditions of  inhalation,  oxygen  never  causes  the  lung-inflammation  and 
exaggerated  vital  processes  predicted  by  Beddoes  and  others. 

Direct  Influence  of  Oxygen  on  the  Heart. — Some  observations  by 
Cyon  on  this  subject  deserve  notice.  Separating  the  heart  of  a  frog,  he 
connected  it  with  a  system  of  glass  tubes  and  a  manometer,  and  then 
passed  through  its  cavities,  first,  serum  saturated  with  carbonic  acid  gas, 
and  afterward  serum  saturated  with  oxygen.  The  former  caused  sudden 
arrest  in  diastole,  while  the  latter  restored  the  movements  of  the  heart 
Mr.  Erichsen  found,  in  experiments  on  asphyxiated  animals,  that  ventri- 


6  MATERIA    MEDICA   AND    THERAPEUTICS. 

cular  contraction  could  be  re-excited  by  oxygen  when  ordinary  air  had  no 
effect.  According  to  Hermann,  oxygen  is  not  indispensable  for  the  cardiac 
contractions — they  may  occur  without  it,  but  irregularly;  and  if  the  gas 
be  absent,  or  supplied  in  insufficient  quantity,  regular  and  synchronous 
contractions  are  impossible  (Robin's  Journal  d' Anatomic  et  de  Physio- 
logic, 1868-70). 

Musculo- Nervous  System. — Many  observers  have  localized  in  the  mus- 
cular system  the  special  action  of  oxygen,  and  Spallanzani,  finding  that 
a  chrysalis  absorbed  much  less  of  the  gas  than  a  butterfly,  argued  that 
the  difference  was  determined  by  the  less  movement  of  the  former. 
Brovvn-Sequard  has  shown,  by  interesting  experiments,  that  when  the 
muscular  and  the  nerve  tissues  have  lost  their  vital  properties,  they  may 
recover  them  under  the  influence  of  freshly  oxygenated  blood  ("  Journal," 
1858).  Thus,  having  injected  some  of  his  own  blood  (defibrinated  and 
charged  with  oxygen)  into  the  radial  artery  of  a  man  executed  thirteen 
hours  previously,  and  whose  limbs  were  quite  rigid,  muscular  irritability 
returned  to  the  hand.  In  another  case  he  removed  the  arm,  and  three 
hours  later,  when  rigor  mortis  was  complete,  he  injected  dog's  blood 
through  the  brachial  artery,  and  the  rigidity  disappeared,  first  in  the 
fingers,  then  in  other  parts;  the  skin  resumed  its  color,  became  elastic  and 
supple,  and  the  hair-bulbs  projected  (goose-flesh).  In  animals  the  vital 
qualities  could  not  be  restored  so  long  after  death;  but,  in  one  curious 
experiment,  the  head  of  a  dog  being  cut  off,  was  injected  through  the 
carotid  and  vertebral  arteries,  and  movements  of  the  eyes  and  the  face- 
muscles  continued  for  a  quarter  of  an  hour.  Other  observations  have 
proved  that  oxygen  augments  the  vital  functions  of  the  spinal  cord  and 
motor  and  sensory  nerves,  and  that,  by  the  continued  injection  of  blood 
charged  with  it,  a  dead  body  resists  decomposition  for  upwards  of  fifty 
hours.  Richardson,  injecting  oxygen  into  the  arteries  of  recently  killed 
animals,  tested  the  muscular  irritability  by  Faradic  currents,  and  found 
that  the  gas  (warmed  to  75°  F.)  increased  irritability  very  much,  but  only 
for  a  short  time.  The  onset  of  permanent  rigidity  was  rather  hastened. 

COMPRESSED  AIR. — PHYSIOLOGICAL  ACTION. — This  varies  somewhat 
according  as  to  whether  the  patient  is  wholly  immersed  in  an  atmosphere 
of  air  compressed  to  one-half  to  one  atmosphere  in  a  closed  chamber  for  one 
or  two  hours,  or  whether  he  simply  breathes  it  from  a  reservoir  through 
a  tube  with  closely  fitting  mouthpiece  for  twenty  to  sixty  inspirations. 

The  former  and  older  method,  as  carried  out  by  Reichenhall,  often 
caused  oppression  of  head,  tinnitus,  and  other  disagreeable  sensations, 
but  had  a  sedative  and  equalizing  effect  on  the  circulation,  slowing  heart- 
action,  raising  arterial  tension  and  altering  the  distribution  of  blood, 
lessening  its  amount  in  the  veins  and  increasing  it  in  the  arteries.  It 
increased  also  expectoration  and  excretion  (Burdon  Sanderson:  Practi- 
tioner, vol.  i.). 


OXYGEN.  7 

In  the  more  recent  method  employed  by  Waldenburg  and  Biedert,  the 
extra  compression  amounts  to  only  T^¥  to  -£j  atmosphere,  and  the  good 
results  obtained  are  more  clearly  traceable  to  the  extra  amount  of  oxygen. 
Nutrition  and  blood-formation  are  improved,  the  "  lesser  circulation  "  is 
rendered  freer  and  less  congested,  and  at  the  same  time  the  vital  capacity 
of  the  lungs  is  increased.  The  alternate  use  of  rarefied  air,  which  induces 
rather  opposite  conditions,  is  employed  in  this  method  (Medical  Times, 
ii.,  1877).  Certainly  theory  favors  further  trials  of  "pneumatic  med- 
icine," but  we  require  more  extensive  experience  before  judging  of  its 
merits.  Ducrocq,  indeed,  reports  almost  opposite  conclusions  to  those  of 
Burdon  Sanderson  (Archives  Generale,  September,  1876). 

Mosso  describes  various  anomalous  results  in  the  distribution  of  blood 
in  the  extremities  under  a  pressure  of  two  atmospheres,  and  explains 
them  by  changes  in  the  innervation  of  the  heart,  or,  with  Paul  Bert,  by 
chemical,  rather  than  by  mechanical  changes  (Medical  Record,  1879). 

Workmen  employed  in  making  bridges,  etc.,  under  a  pressure  of  two 
to  three  atmospheres,  suffer  from  pains  in  the  ears  and  joints,  apparently 
due  to  "  dilatation  of  superficial  vessels,"  after  leaving  work.  Among 
a  large  number  of  men  no  hemorrhage,  heart  disease,  or  serious  disorder 
occurred  (Medical  Times,  ii.,  1877;  of.  Moxon:  British  Medical  Journal, 
i.,  1881,  p.  496). 

OZONE. — PHYSIOLOGICAL  ACTION. — Dewar  and  McKendrick  pointed 
out  the  remarkable  fact  that,  instead  of  the  blood  becoming  more  highly 
oxygenated  under  ozone-inhalations,  it  assumes  venous  characters  in  all 
the  vessels,  a  fact  which  is  explained  by  the  greater  density  of  this  gas 
interfering  with  the  due  excretion  of  carbonic  acid  from  the  blood  ;  it 
causes  also  some  local  irritation  of  the  lining  of  the  air-passages,  and  it 
induces  slowing  of  the  heart-action  and  respiration  ("  Proceedings  of  the 
Royal  Society,"  1873-74). 

This  was  not  in  accord  with  previous  observations,  for  Dr.  Ireland  had 
stated  that  ozone  quickened  respiration  and  circulation,  excited  the  ner- 
vous system,  and  promoted  coagulation  of  blood  (Edinburgh  Medical 
Journal,  1862-63,  p.  729),  but  it  is  probable  that  his  animals  respired 
mainly  oxygen.  Day  also  had  found  that  oxygen,  "  ozonized  in  propor- 
tion of  one-twelfth,  caused  rapid  respiration  and  heart-action,  and  much 
local  irritation  ; "  but  quite  recently  Dr.  John  Barlow  has  confirmed  and 
added  to  the  observations  of  Dewar  and  McKendrick.  He  reports  that 
ozonized  air  depresses  the  nervous  system,  probably  through  leading  to 
accumulation  of  carbonic  acid  in  the  blood;  it  lessens  the  frequency  of 
respiration,  and  hence  also  of  heart-action,  together  with  the  excretion  of 
carbonic  acid  and  the  absorption  of  oxygen.  It  irritates  the  pulmonary 
mucous  membrane,  and  may  cause  bronchitis  or  lung-congestion  (Red- 
fern),  or  even  asphyxia.  It  decolorizes  the  red  corpuscles,  and  causes  a 
granular  appearance,  probably  from  uniting  with  haemoglobin;  it  stops 


8  MATERIA    MEDICA    AND    THERAPEUTICS. 

the  amoeboid  movements  of  the  white  corpuscles,  and  renders  the  nucleus 
apparent  ;  there  is  no  evidence  of  its  entering  the  circulation  in  a  free 
state. 

As  illustrating  its  irritant  effect,  Dr.  Barlow  records  its  producing 
an  obstinate  inflammation  of  the  nasal  membrane  (Journal  of  Anatomy, 
October,  1879). 

THERAPEUTICAL  ACTION  (EXTERNAL). —  Ulceration — Gangrene. — The 
gas  has  been  applied  in  jet  to  atonic  scrofulous  ulcers  by  M.  Demarquay, 
with  much  advantage. 

Gangrene  has  been  attributed  by  M.  Raynaud  to  deficient  oxygenation 
of  tissue,  and  Langier  and  other  French  surgeons  have  recorded  good  re- 
sults from  its  local  treatment  by  oxygen  (Bulletin de  Therapeutique,  1863- 
66).  The  destruction  of  tissue  has  been  checked  and  limited,  the  swelling 
subdued,  and  the  neighboring  threatened  livid  tissue  restored  to  its  natural 
color.  Dr.  Goolden  has  recorded  severe  cases  of  phagedenic  ulceration, 
especially  one  affecting  the  throat,  which  yielded  to  local  application  of 
oxygen,  and  he  has  recently  written  to  renew  his  advocacy  of  this  remedy 
(Lancet,  i.,  1866;  ii.,  1879). 

THERAPEUTICAL  ACTION  (INTERNAL). — Inhalation. — Remedially,  oxy- 
gen may  be  considered  as  it  exists  diluted  in  the  atmosphere,  or  as  pre- 
pared artificially  for  inhalation  with  a  definite  proportion  of  air. 

Pure  fresh  air  of  the  elevated  country  or  the  coast  is  of  well-known 
efficacy  in  all  conditions  of  debility,  of  chronic  catarrh  and  chronic  dys- 
pepsia; sea-air  especially  contains  more  ozone  than  the  air  of  land,  and 
is  of  value  to  those  who  have  lived  in  towns  and  followed  sedentary  oc- 
cupations. On  the  other  hand,  patients  with  weak  chests  and  readily 
congested  lungs  are  better  in  a  less  rare  and  less  ozonized  atmosphere, 
since  a  large  proportion  of  ozone  may  excite  in  them  irritation  of  mucous 
membrane  (Cornelius  Fox).  During  epidemics  of  influenza  an  unusual 
amount  of  ozone  has  been  verified  in  the  air,  while  in  cholera  epidemics 
it  has  been  almost  absent.  The  choice  of  a  climate  for  any  given  case  is, 
however,  generally  influenced  by  other  considerations  than  the  mere 
amount  of  oxygen  to  be  obtained;  the  subject  need  not,  therefore,  be 
fully  considered  in  this  place.  The  chief  cases  in  which  theory  indicates, 
and  experience  justifies,  the  use  of  oxygen-inhalation,  are  those  of  as- 
phyxia and  of  venous  congestion  occurring  in  the  course  of  phthisis,  asth- 
ma, or  emphysema. 

ASPHYXIA. — When  this  condition  is  induced  by  breathing  noxious 
gases,  the  best  results  are  obtained  from  oxygen.  Sometimes  a  free  cur- 
rent of  fresh  air  is  sufficient  to  restore  persons  rendered  unconscious  by 
an  escape  of  gas  or  by  the  products  of  combustion  retained  within  a 
room.;  but,  in  extreme  cases,  pure  oxygen  would  seem  the  only  means  of 
saving  life.  Limousin  has  reported  a  case  of  asphyxia  from  carbonic  acid 
inhalation,  with  intense  cyanosis,  which  recovered  under  the  use  of  oxy- 


OXYGEN. 

gen,  and  in  which  he  was  able  to  verify  a  steadily  increased  elimination  of 
carbonic  acid  by  the  lung,  in  proportion  to  the  oxygen  taken  (  Comptes 
Rendus,  Societe  de  Therapeutique,  1868).  M.  Constantin  Paul  has  re- 
corded many  cases,  including  cyanosis  from  obstructed  respiration,  coma 
from  opium-poisoning  (when  the  respirations  were  only  seven  per  minute), 
and  asphyxia  from  carbonic  oxide,  all  quickly  and  markedly  relieved  by 
oxygen  (Bulletin  de  Therapeutique,  August,  1868).  Rabuteau  refers  to 
an  instance  of  its  good  effect  in  asphyxia  from  sewer-gas,  when  ordinary 
means,  employed  by  M.  Griscolle,  had  failed  to  relieve  ("  Elements,"  p. 
48)  ;  and  finally  I  may  quote  a  striking  case  recently  reported  by  Dr. 
Charles  B.  Ball.  A  man,  wife,  and  daughter,  were  found  unconscious 
in  a  small  room  where  there  had  been,  through  the  night,  a  large  fire, 
though  the  chimney  was  blocked.  The  two  adults  recovered  with  fresh 
air  and  ordinary  means,  but  the  daughter,  aged  sixteen  (phthisical),  re- 
mained unconscious  and  convulsed.  After  many  hours  of  stimulating 
treatment  she  seemed  to  be  dying  ;  respiration  was  feeble  and  slow,  the 
pulse  imperceptible;  then  she  was  made  to  inhale  pure  oxygen,  afterward 
oxygen  and  air.  "  The  effects  were  rapid  and  marked:  "  respiration,  color, 
and  pulse  improved,  and  though  at  -first  convulsed,  she  ultimately  re- 
covered. Dr.  Ball,  impressed  by  this  case,  and  remembering  Reynault's 
proof  that  man  can  live  in  an  atmosphere  strong  in  carbonic  acid,  pro- 
vided that  the  proportion  of  oxygen  is  also  increased,  has  contrived  an 
apparatus  with  a  reservoir  of  oxygen  and  a  mask  for  safe  use  in  dangerous 
mines.  He  has  himself  safely  respired  an  atmosphere  containing  18  per 
cent,  carbonic  acid  with  30  per  cent,  oxygen  added  (British  Medical  Jour- 
nal, i.,  1878).  If  we  compare  the  result  in  Dr.  Ball's  case  with  the  fatal 
course  of  such  cases  of  gas-asphyxia  as,  e.g.,  may  be  found  in  the  Edin- 
burgh Journal,  1874,  we  shall  better  realize  the  importance  of  using 
oxygen  in  preference  to  other  measures.  In  various  forms  of  poisoning, 
whenever  death  threatens  from  asphyxia,  as  under  prussic  acid,  chloro- 
form, etc.,  artificial  respiration,  i.e.,  supplying  more  oxygen,  offers  the 
best  means  of  saving  life. 

Rosenthal  and  Leube  found  that  the  symptoms  of  strychnia-poison- 
ing might  be  deferred  or  prevented  by  artificial  respiration  (Reichert's 
Archiv,  1867).  H.  Ebner  thought  the  same  result  could  be  obtained  by 
rhythmical  movements  of  the  limbs  without  supplying  more  air  to  the 
lungs,  but  Ananoff  has  since  proved  that  pure  oxygen  is  distinctly  an- 
tagonistic to  strychnia-action,  and  that  when  supplied  to  animals  poisoned 
by  this  alkaloid  it  relieves  them  more  than  free  access  of  ordinary  air,  or 
any  movements  ( Gentralblatt  fur  Medicin,  No.  27,  1874). 

Asthma — Emphysema,  etc. — The  main  suffering,  the  "  besoin  de  res- 
pirer,"  common  to  these  maladies,  is  clearly  traceable  to  deficient  access 
of  oxygen  to  the  blood  in  the  lung-capillaries,  and  I  arn  satisfied  that  in 
the  majority  of  instances  relief  to  this  suffering  may  be  given  by  sup- 


10  MATEBIA    MEDIOA    AND    THERAPEUTICS. 

plying  a  larger  proportion  of  the  gas.  If  it  be  objected  that  permanent 
good  results  are  not  obtained  from  it,  the  same  objection  may  be  made 
to  many  other  remedies  ;  it  is  still  something  to  have  a  means  at  hand 
for  temporary  relief.  Dr.  John  Hooper  thus  describes  its  effects  in  a  man 
of  fifty-five,  "  for  many  years  a  martyr  to  asthma."  During  a  very  severe 
paroxysm  he  was  thought  to  be  dying — it  seemed  impossible  that  he 
could  rally.  As  a  dernier  ressort,  oxygen  was  tried,  the  end  of  a  glass 
retort  containing  it  being  applied  to  his  mouth,  though  he  had  not  power 
to  enclose  it  with  his  lips.  "  The  effect  was  wonderful  and  quickly  mani- 
fest in  increased  mobility  of  the  ribs,,  fuller  inspiration,  disappearance  of 
lividity,  and  lastly  in  his  seizing  the  end  of  the  retort,  and  in  the  avidity 
with  which  he  inhaled  when  possessing  the  voluntary  power"  (British 
Medical  Journal,  i.,  1862).  Details  of  diagnosis  are  not  given  in  this 
instance,  but  paroxysms  of  true  nervous  asthma  and  of  bronchitic  asthma 
may  both  be  shortened  by  similar  inhalation.  Beddoes  related  twenty- 
two  cases,  of  which  he  claimed  to  have  cured  ten  and  relieved  nine  ;  and 
it  seems  worth  while  to  refer  to  his  case  of  "  Mr.  Hare,  of  Conduit  Street, 
who,  in  1796,  after  having  been  subject  for  eleven  years  to  asthmatic  at- 
tacks accompanied  by  indescribable  suffeatog,  and  only  relieved  after 
many  hours  by  blisters  and  expectorants,"  recovered  average  health  un- 
der the  use  of  the  gas  continued  for  some  months  (op.  cit.,  4th  part,  p. 
49).  M.  Demarquay  also  witnessed  excellent  results,  e.g.,  in  a  man  aged 
nineteen,  subject  from  childhood  to  asthmatic  attacks:  "they  ceased,  as 
if  by  magic,  as  soon  as  he  began  to  inhale  oxygen  ("  Essai  de  Pneumato- 
logie,"  p.  725). 

Dr.  Mackey  has  reported  a  good  illustration  of  the  value  of  the  gas  in  ad- 
vanced emphysema  pulmonum  (Practitioner,  vol.  ii.,  May,  18G9).  A  lady, 
aged  fifty-five,  was  subject  to  constant  dyspnoea,  increased  by  every  move- 
ment, and  amounting  at  times  to  partial  asphyxia.  She  had  the  physical 
signs  of  the  malady,  together  with  dilated  weak  heart  and  embarrassed  cir- 
culation, as  evidenced  by  osdema  of  the  face  and  extremities;  was  subject 
to  attacks  of  bronchitis,  but  at  the  time  of  treatment  the  main  complaint 
was  the  difficulty  of  breathing.  She  inhaled  a  mixture  of  from  three  to 
twelve  pints  of  oxygen,  with  sixty  of  air,  at  intervals  of  three  or  four 
days,  for  a  period  of  six  weeks.  After  each  dose  "  marked  relief  was  ex- 
perienced, which  she  expressed  as  being  able  to  take  a  deep  breath  and 
get  sufficient  air  (a  feeling  not  known  for  years),  as  being  able  to  move 
with  comparative  ease,  feeling  more  buoyant  and  more  like  healthy  per- 
sons should  feel  than  she  ever  remembered."  Expectoration  was  rendered 
more  copious  and  facile  for  a  day  or  two  after  the  inhalation  ;  there  was 
no  other  definite  effect  on  secretion,  nor  any  on  circulation,  unless  it  were 
some  palpitation  during  the  night  after  a  large  dose.  The  nervous  irri- 
table states  to  which  such  patients  are  liable  were  also  soothed  under  the 
treatment,  which  certainly  effected  more  than  ordinary  medicinal  agents. 


OXYGEN.  11 

It  could  not,  however,  alter  the  organic  conditions,  and  cardiac  death 
occurred  suddenly,  after  an  attack  of  bronchitis,  in  the  following  win- 
ter. 

These  illustrations  seem  to  me  sufficient  to  prove  that  oxygen  might 
he  used  more  often  than  it  commonly  is  in  such  cases.  According  to 
Biedert's  method,  emphysema  is  treated  by  a  few  short  sittings  of  res- 
piration in  compressed  air,  and  then  by  expirations  into  an  atmosphere 
of  rarefied  air,  "  in  order  to  counteract  anaemia  by  attracting  blood  to- 
ward the  lung-tissue." 

In  Bronchitis,  bronchial  catarrh,  and  bronchial  asthma,  compressed  air 
is  used  to  stimulate  the  lung,  improve  its  circulation,  and  facilitate  ex- 
pectoration ;  it  seems  to  be  useless  during  actual  asthmatic  attacks.  In 
mitral  disease  it  is  said  to  be  valuable,  and  in  dyspnoaa  dependent  on 
dilatation  of  the  right  heart. 

Pleuritic  Effusion — Empyema. — I  have  used  oxygen  in  several  of 
these  cases  with  good  results.  During  inhalation  relief  to  breathing  was 
experienced,  which  lasted  for  some  time  afterward;  compressed  air  has 
also  been  employed  for  these  disorders.  Biedert  reports  two  cases  of 
pleuritic  adhesion  in  which  vital  capacity  was  much  increased  by  it,  and 
Kelemen  one  of  empyema  in  which  the  effusion  disappeared  as  diuresis 
set  in  (Medical  Record,  August,  1879). 

Whooping- Cough. — Moutard-Martin  says  that  compressed  air  baths 
are  efficient  in  this  complaint  (Union  Medical,  March  11,  1879). 

Phthisis. — The  true  value  of  oxygen-inhalations  in  this  disease  has 
been  the  subject  of  much  discussion.  So  early  as  1783  it  was  tried  with 
apparent  good  result,  and  Fourcroy  was  appointed  by  the  French  Govern- 
ment to  report  on  the  subject.  After  examining  into  twenty  cases  he 
concluded  that  almost  all  patients,  benefited,  for  a  time  at  least,  by  the 
treatment,  but  relapsed  and  got  worse  more  rapidly  and  with  more  in- 
flammatory complication  than  if  oxygen  had  not  been  used  ("  Sur  les 
Proprietes  Medicinales  de  PAir  Vital,"  1789). 

It  is  evident  that  to  establish  such  a  conclusion  very  careful  observa- 
tion is  required,  and  more  precision  than  the  then  art  of  diagnosis  could 
attain;  but  the  opinion  exercised  considerable  influence  at  the  time,  was 
adopted  by  Dr.  Beddoes  and  some  other  observers,  and  was  one  reason 
why  this  method  of  treatment  fell  into  a  disuse  which  was  not  altogether 
deserved. 

Among  modern  writers,  Dr.  Birch,  Constantin  Paul,  and  Demarquay 
have  reported  relief  in  cases  of  phthisis,  and  the  following  occur  among 
others  related  by  Dr.  Mackey.  Mrs.  W.,  aged  thirty-one,  of  phthisical 
family,  when  first  seen  had  had,  for  six  months,  cough,  emaciation,  and 
latterly  diarrhoea,  night-sweating,  hectic,  haemoptysis,  and  purulent  expec- 
toration ;  much  chest-pain  ;  there  were  dulness  and  crepitation  at  left 
apex.  After  some  months  of  treatment  of  the  usual  recognized  kind,  she 


12  MATERIA    MEDICA    AND    THERAPEUTICS. 

improved,  and  complained  mostly  of  debility,  cough,  pain,  expectoration, 
and  dyspnoea.  She  commenced  oxygen-inhalations  (six  to  twelve  pints 
in  sixty).  After  eight  inhalations,  at  intervals  of  two  days,  all  these 
symptoms  were  markedly  better,  and  treatment  was  omitted.  The  mal- 
ady was  arrested  for  a  time,  but,  after  exposure  to  poverty  and  misfor- 
tune, this  patient  died  one  or  two  years  later. 

R.,  aged  nineteen,  with  family  history  of  phthisis,  after  partial  recov- 
ery from  acute  softening  of  the  right  apex,  commenced  inhalation  as  a 
remedy  for  dyspnoea  and  pain  in  the  chest,  and  at  the  end  of  two  months 
was  sufficiently  recovered  to  resume  the  sedentary  work  of  a  clerk.  It 
should  be  stated  that  iron  and  cod-liver  oil  were  given  throughout,  but 
the  patient  distinguished  definite  relief  to  his  breathing  from  the  use  of 
the  gas.  He  was  in  fair  health  six  months  afterward,  when  the  case  was 
reported,  but  he  died  within  eighteen  months,  of  acute  phthisis  following 
imprudent  exposure. 

A  third  patient,  a  man  aged  thirty-four,  commenced  inhalation  while 
still  suffering  from  acute  symptoms  dependent  on  softening  tubercle,  and 
continued  it  for  nearly  three  months,  with  marked  improvement  as  to 
breathing-power,  cough,  expectoration,  and  appetite.  In  this  case  the 
end  came  by  pneumonia  and  pleuritic  effusion,  but  after  a  prolonged  ex- 
posure to  bad  weather,  and  independently  of  the  treatment. 

Such  cases  in  themselves  do  not  show  more  than  a  temporary  relief 
of  symptoms,  and  at  least  no  harm  from  the  gas,  and  they  are  really  too 
few  for  any  conclusions.  A  larger  number  are  given  by  Dr.  A.  H.  Smith 
("New  York  Prize  Essay"),  and  his  general  results  are  so  far  favorable 
as  to  warrant  still  further  trials  with  this  agent.  I  would  except  from  its 
use  cases  of  very  acute  character,  and  of  haemoptysis,  in  which,  indeed, 
the  mere  exertion  of  inhaling  would  contra-indicate  it.  In  other  cases 
benefit  may  be  hoped  for,  not  so  much  through  any  local  action  on  the 
lung-tissue  as  through  improvement  of  the  blood-condition,  the  appetite, 
and  the  power  of  assimilation;  nor,  speaking  from  experience,  do  I  believe 
that  oxygen,  used  with  ordinary  care  and  in  such  dilution  as  has  been 
mentioned,  can  at  all  irritate  or  inflame  the  lung-tissue. 

Dr.  Read  (Long  Island)  has  reported  a  series  of  twenty  cases  treated 
by  inhalations  of  oxygen  in  conjunction  with  cod-liver  oil.  The  majority 
did  well,  and  he  reports  it  "an  admirable  adjuvant  to  the  usual  routine 
treatment  of  phthisis,  especially  when  the  patients  were  unable  to  go  out 
of  doors."  He  gave  the  gas  also  in  acute  pneumonia,  and  apparently 
with  advantage.  The  use  of  compressed  and  rarefied  air  seems  rather  to 
alleviate  symptoms  than  to  cure  phthisis.  In  pretubercular  stages  it  may 
serve  to  strengthen  the  respiratory  muscles  and  open  out  the  chest,  but 
it  is  not  suitable  for  acute  or  hemorrhagic  cases,  or  those  with  a  krgo 
area  of  congestion. 

Hepatic  Congestion. — Dr.  Birch  has  advocated  the  use  of  the  gas  in 


OXYGEN.  13 

this  condition,  and  states  that  it  will  relieve  the  constipation  and  other 
symptoms  connected  with  it.  The  remedy  has  no  doubt  been  of  service, 
especially  in  cases  with  much  headache,  depression,  loss  of  appetite,  and 
sense  of  pain  and  constriction  about  the  shoulder  and  chest,  with  palpi- 
tation and  dyspncea.  In  some  chronic  cases  in  which  it  was  tried  I  have 
not  seen  benefit,  and,  as  a  general  rule,  medicinal  and  dietetic  treatment, 
with  such  oxygen  as  is  obtained  by  increased  exercise,  will  give  at  least 
more  rapid  results. 

Chlorosis — Anaemia. — Beddoes  relates  many  instances  of  chlorosis 
benefited  by  inhalations,  but  other  observers  have  not  met  with  equal 
success  from  its  use  in  this  malady.  I  have,  however,  known  it  to  relieve 
chlorotic  headache.  In  extreme  cases  of  anaemia  the  gas  is  not  always 
well  borne;  it  has  seemed  sometimes  to  increase  depression  for  the  time, 
and  cause  faintness  and  palpitation. 

Diabetes. — Pettenkofer  and  Vogt  determined  that  diabetics  absorbed 
less  oxygen  than  healthy  persons,  and  that  hence  we  might  hope,  by  in- 
troducing more  into  their  system,  to  obviate  some  conditions  of  their 
malady. 

Bouchardat,  and  also  Demarquay,  have  recorded  cases  relieved  by  this 
treatment,  but  no  extensive  trial  of  it  has  been  made.  Peroxide  of  hy- 
drogen has  been  given  internally  with  the  same  object — of  oxygenation — 
and  with  some  partial  success. 

I  have  tried  oxygen-inhalation  in  several  cases  of  diabetes  in  which 
prostration,  dyspncea,  and  tendency  to  cyanosis  were  prominent  symptoms 
— one  case  was  at  the  very  unusual  age  of  seventeen  months,  another  at 
thirteen  years,  and  three  others  at  adult  age.  The  gas  certainly  relieved 
for  a  time  the  symptoms  mentioned,  although  it  did  not  in  any  instance 
reduce  the  sugar  in  the  urine. 

Albuminuria. — In  a  few  cases  of  Bright's  disease,  narrated  by  Dr.  C. 
Paul,  albumen  disappeared  from  the  urine  during  treatment  by  oxygen. 
This  occurred  also  in  the  often-quoted  case  observed  by  Kollman  and 
Eckart  (Schmidt's  Jahrb.,  1865).  More  recently,  Dujardin  Beaumetz  re- 
ports a  case  "in  the  last  stage,"  and  in  which  every  diuretic  had  proved 
useless,  and  yet,  twenty-four  hours  after  inhaling  oxygen,  the  albumen 
disappeared,  and  was  still  absent  twelve  days  afterward  when  the  case 
was  reported  (Medical  Itecord,  March,  1879).  Other  physicians,  while 
recording  similar  cases  in  their  own  experience,  stated  that  the  good  re- 
sult was  not  of  long  duration. 

Nerve  Disorders. — A  few  cases  of  severe  neuralgia  relieved  by  oxygen 
are  on  record  (Birch,  J.  Hooper:  loc.  cit.),  and  it  has  been  praised  in  spi- 
nal palsy,  nerve  debility,  and  hysteria,  but  I  think  without  sufficient  rea- 
son. What  little  trial  I  have  made  of  it  in  such  cases  has  not  given  me 
any  good  result. 

Dr.  Ramskill  has  reported  a  case  of  epilepsy  apparently  relieved  by 


14  MATERIA   MEDICA    AND    THERAPEUTICS. 

the  gas,  which  he  gave  by  inhalation  from  peroxide  of  hydrogen  (Medical 
Times,  i.,  1863). 

Hydrophobia. — Drs.  Paul  and  Josias  used  oxygen  in  this  malady,  and, 
although  the  patients  died,  some  relief  was  given  to  the  symptoms  of  as- 
phyxia. Recently  Dr.  Schmidt  has  recorded  the  case  of  a  girl,  aged 
twelve,  who,  when  recovering  from  diphtheria,  was  bitten  by  a  mad  dog; 
seventeen  days  afterward  she  had  difficulty  of  breathing  and  of  swallow- 
ing, and  oxygen-inhalation  relieved  her;  she  relapsed  next  day  with  con- 
vulsions, spasms  of  respiratory  muscles,  and  unconsciousness;  oxygen 
again  relieved  her,  and,  after  some  complications  traceable  to  the  diph- 
theria, she  ultimately  recovered  (Medical  Record,  1878). 

Tetanus — Strychnia- Poisoning. — Richardson  refers  to  some  cases  of 
tetanus,  under  Sir  J.  Paget,  much  relieved  by  oxygen-inhalation;  the  pa- 
tients became  bathed  in  perspiration,  and  the  muscles  relaxed.  He  insists 
also  on  its  importance  in  strychnia-poisoning  in  conjunction  with  amyl 
nitrite,  as  unless  elimination  be  promoted  by  oxygen,  the  spasm,  even  if 
relieved,  soon  returns.  "  Oxygen  is  a  remedy  for  all  excess  of  nerve-ac- 
tion leading  to  spasm  "  (cf.  p.  12). 

MODE  OF  ADMINISTRATION. — M.  Demarquay  obtained  his  oxygen  from 
chlorate  of  potash,  and  made  use  of  caoutchouc  bags,  which  were  filled 
with  the  washed  gas  and  could  be  carried  to  the  patient's  bedside.  M. 
Limousin  has  introduced  a  small  portable  apparatus  with  brass  retort, 
wash-bottle,  and  caoutchouc  bag,  so  that  the  gas  can  be  prepared  and 
used  on  the  spot;  but  in  this  country  the  most  available  method  is  that 
of  Mr.  Barth,  of  Bloomsbury:  he  supplies  a  small  gasometer,  with  the  gas 
condensed  under  high  pressure  into  iron  bottles,  from  which  a  measured 
quantity  can  be  introduced  and  mixed  in  definite  proportion  with  air, 
and  then  inhaled  in  the  usual  way.  This  method  leaves  nothing  to  be 
desired.  The  patient  should  be  quiet  for  a  time  before  and  after  inhala- 
tions, and  not  be  over-fatigued;  the  stomach  should  be  neither  full  nor 
quite  empty;  the  feet  should  be  warm,  and  the  circulation  equable.  Other 
modes  have  been  devised  for  introducing  oxygen  into  the  system,  as  by 
oxygenated  water  and  oxygenated  bread,  but  I  have  no  confidence  in 
these  preparations.  A  method  still  open  to  investigation  is  the  adminis- 
tration of  peroxides,  especially  those  of  hydrogen  and  of  iron,  and  of 
chlorate  or  permanganate  of  potash  (v.  Potash);  and  some  experiments 
of  C.  Bernard  warrant  the  conclusion  that  these  compounds  give  up  to 
the  blood  a  proportion  of  their  oxygen,  and  are  eliminated  in  a  less  oxi- 
dized condition. 

CoNTRA-IxDiCATioxs. — I  have  not  met  with  any  case  wherein  oxygen, 
more  or  less  diluted,  was  indicated,  and  could  not  be  safely  used.  If  or- 
ganic heart  disease  be  present,  care  should  be  taken  to  regulate  the  force 
and  the  effort  of  inhaling,  which  sometimes  gives  rise  to  giddiness  or  pal- 
pitation independent  of  the  remedy.  Some  soreness  of  the  throat,  and 


NITROGEN.  15 

temporary  discomfort  about  the  mouth,  may  occur  if  the  apparatus  be  not 
quite  free  from  dust;  but  from  the  gas  I  have  seen  no  bad  results  what- 
ever. The  contra-indications  to  the  use  of  compressed  air  are  degenera- 
tion of  vessels  and  an  apoplectic  tendency;  to  that  of  rarefied  air,  pul- 
monary hemorrhage. 


NITROGEN,  N,=14, 

This  gas  is  very  widely  diffused,  constituting  76.99  per  cent,  by  weight 
of  the  atmosphere,  79.19  percent,  by  measure.  In  combination,  it  occurs 
in  the  mineral  kingdom  as  the  basis  of  nitrates,  nitrites,  etc.,  it  enters 
into  the  composition  of  almost  all  animal  tissues,  and  in  the  vegetable 
kingdom  it  is  found  as  a  constituent  of  the  alkaloids  and  the  most  active 
medicines,  as  well  as  of  the  most  nourishing  foods. 

PREPARATION. — Nitrogen  may  be  obtained  by  burning  either  phos- 
phorus or  a  mixture  of  iron  filings  and  sulphur,  or  certain  other  sub- 
stances, in  a  limited  quantity  of  air,  as  under  a  bell- jar:  the  oxygen  will 
be  taken  up  and  only  nitrogen  left.  The  process  is  not  an  easy  one,  and 
hence,  possibly,  the  little  trial  so  far  made  of  the  gas  in  medicine. 

CHARACTERS. — A  colorless,  odorless  gas,  sp.  gr.  .975,  soluble  in  water 
to  some  extent. 

PHYSIOLOGICAL  ACTION. — This  is  negative  in  character;  the  gas  will 
not  support  respiration  ("  azote  ")  nor  combustion,  and  it  seems  to  act  in 
the  atmosphere  as  a  diluting  agent  for  the  too  stimulating  oxygen.  M. 
Demarquay  injected  nitrogen  into  the  peritoneum  and  cellular  tissue  of 
animals,  and  came  to  the  conclusion  that  more  or  less  exhalation  from 
the  lungs,  etc.,  of  the  normal  gases  of  the  blood  was  caused  by  it  (Archives 
Generates,  1859). 

THERAPEUTICAL  ACTION  (EXTERNAL). — On  the  hypothesis  that  the 
stimulation  of  ordinary  air  caused  irritation  and  suppuration  in  wounds, 
stumps,  etc.,  M.  Demarquay  was  led  to  try  the  effect  of  enclosing  them 
in  caoutchouc  bags  full  of  nitrogen;  but  the  practice  was  not  successful. 

THERAPEUTICAL  ACTION. — INHALATION. — It  has  been  proposed  to 
utilize  nitrogen  by  adding  a  larger  than  normal  proportion  of  it  to  ordi- 
nary air  for  inhalation  in  irritable  and  inflammatory  lung-condition,  but 
no  definite  results  have  been  obtained  in  this  country.  Steinbrtick  (Vienna) 
has,  however,  lately  recommended  nitrogen-inhalations  in  the  first  and 
second  stages  of  phthisis  in  young  persons,  stating  that  "  they  lower  the 
circulation  and  allay  nerve-irritability,  give  great  relief,  and  sometimes 
cure;  "  in  the  third  stage  they  are  injurious  (DobelVs  Iteports,  1876).  T 
have  not  seen  any  confirmation  of  these  results.  The  power  of  nitrous 
oxide  as  an  anaesthetic  has  been  largely  developed  in  recent  times  (v. 
Anaesthetics). 


16  MATERIA    MEDICA    AND    THERAPEUTICS. 


HYDROGEN,  H,=l. 

Hydrogen,  being  the  lightest  of  known  elements,  is  commonly  taken  as  a 
standard  of  specific  gravity  and  combining  proportion.  It  has  been  found 
free  in  small  proportions  in  certain  volcanic  gases,  and  occurs  extensively 
in  combination,  e.g.,  in  water,  in  many  acids  and  gases,  in  hydrocarbons, 
and  all  substances  used  for  artificial  light — tallow,  oils,  coal-gas,  etc. — 
and  throughout  the  vegetable  kingdom.  It  was  formerly  known  as  "  in- 
flammable air,"  and  when  lighted  burns  with  a  bluish  flame. 

PREPARATION. — By  acting  on  granulated  zinc  with  dilute  sulphuric 
or  hydrochloric  acid— Zn  +  HaSO4=:ZnSO4  +  H2 

CHARACTERS. — A  colorless,  inodorous  gas,  of  sp.  gr.  0.0692. 

PHYSIOLOGICAL  ACTION. — This  is  negative  in  character.  Hydrogen 
does  not  support  respiration  or  combustion,  and  Priestley  ascertained 
that  animals  immersed  in  it  died  as  soon  as  in  carbonic  acid.  Beddoes 
found  that  attempts  to  inhale  it  caused  cyanosis  of  lips  and  face,  quick- 
ness and  smallness  of  pulse,  vertigo,  impaired  vision,  and  in  some  persons, 
drowsiness,  slight  insensibility,  and  when  pushed,  asphyxia  in  greater  or 
less  degree.  A  mixture  with  oxygen,  when  inhaled,  causes  the  voice  to 
become  shrill. 

THERAPEUTICAL  ACTION. — Dr.  Beddoes  used  hydrogen  gas  as  an  in- 
halation in  phthisis,  both  by  itself  and  in  mixture  with  oxygen.  He 
reported  some  cases  as  relieved  and  others  cured,  but  his  results  have  not 
been  corroborated.  The  most  constant  effect  seems  to  have  been  the 
production  of  sleep. 

HYDROGEN II  PEROXIDUM— PEROXIDE  OF  HYDROGEN,  H.0^34. 

PREPARATION. — By  acting  on  barium  peroxide  with  hydrochloric  acid. 

CHARACTERS. — This  compound  of  hydrogen  is  a  liquid  of  the  con- 
sistence of  syrup,  of  strong,  disagreeable,  metallic  taste,  very  unstable, 
and  readily  parting  with  its  oxygen;  hence,  it  is  a  powerful  oxidizer.  It 
blanches  a  solution  of  litmus.  A  solution,  of  sp.  gr.  1,006,  is  in  common 
use  abroad  for  bleaching  purposes,  and  is  said  to  be  permanent. 

PHYSIOLOGICAL  ACTION  (EXTERNAL). — This  liquid,  applied  locally, 
whitens  the  skin  and  mucous  membranes,  and  acts  as  a  moderate  caustic. 
It  has  also  marked  antiseptic  power,  though  not  equal  to  carbolic  acid  in 
that  respect.  Urine  mixed  with  one-tenth  of  peroxide  remained  nine 
months  without  putrefying  (Guttmann).  The  patent  disinfectant  termed 
"  Sanitas  "  is  said  to  depend  for  its  efficacy  mainly  upon  this  peroxide. 

PHYSIOLOGICAL  ACTION  (INTERNAL). — It  produces,  when  given  inter- 
nally, some  oxidizing,  stimulating,  and,  in  full  doses,  irritant  effects.  The 
bleaching  solution,  of  sp.  gr.  1,006,  has  been  used  by  Assmuth,  Schmidt, 


HYDROGEN.  1 7 

and  Gutttnann  for  hypodermic  injection  in  animals,  and  found  to  cause 
dyspnoea,  clonic  convulsions,  and  death  in  a  few  minutes  from  asphyxia. 
The  last-named  observer  traces  this  to  the  development  of  bubbles  of  gas 
in  the  right  cavities  of  the  heart,  the  blood  frothing  up  as  if  air  entered 
by  the  veins.  The  result  is  partially  antagonized  by  injection  of  ferrous 
sulphate,  implying  the  combination  of  this  with  part  of  the  oxygen  liber- 
ated (Abstract,  Medical  Times,  ii.,  1878). 

THERAPEUTICAL  ACTION  (EXTERNAL). —  Ulcerations. — Lotions  con- 
taining peroxide  have  been  used  with  advantage  in  soft  chancre  and  in 
cases  of  fetid  ulcerations  of  the  mouth. 

THERAPEUTICAL  ACTION  (INTERNAL). —  Chronic  Dyspepsia. — Richard- 
son, Guttmann,  and  others  have  reported  improvement  of  the  digestion 
under  this  remedy,  but  it  is  not  much  used. 

Diabetes. — Cases  of  this  disorder  treated  successfully  by  peroxide  of 
hydrogen  have  been  recorded  (British  Medical  Journal  and  Lancet, 
1868),  and  much  good  was  at  one  time  expected  from  it  as  an  oxidizing 
agent;  but  Dr.  B.  W.  Richardson,  who  introduced  the  remedy  and  used 
it  in  more  than  two  hundred  cases,  came  to  the  conclusion  that,  although 
it  could  reduce  the  specific  gravity  of  the  urine,  it  at  the  same  time  in- 
creased its  quantity,  and  had  no  really  good  effect  (Medical  Times,  ii., 
1868).  Dr.  Pavy  tried  it  in  a  few  cases  without  any  result  ("  On  Dia- 
betes," p.  268). 

Cyanosis — Pulmonary  Congestion  (Passive). — In  these  conditions, 
where  oxygenation  of  the  blood  is  defective,  and  which  are  generally 
connected  with  heart  disease,  I  have  sometimes  seen  advantage  from  the 
internal  use  of  peroxide  of  hydrogen — it  is  worth  trial,  but  further  ob- 
servations are  needed  for  estimating  its  true  powers.  Dr.  B.  W.  Foster 
has  reported  two  cases  of  congenital  cyanosis  relieved  by  it  ("  Clinical 
Medicine,"  1874). 

Phthisis — Strutna. — I  have  no  personal  experience  of  its  use  in  these 
diseases,  but  benefit  has  been  reported  from  it.  In  early  stages  it  is  said 
to  improve  digestion,  in  later  stages  to  relieve  dyspnoaa,  and  in  struma 
to  cause  absorption  of  glandular  swellings  (Ranking,  1868). 

Pertussis. — Much  power  has  been  claimed  for  peroxide  of  hydrogen  in 
the  relief  of  paroxysms  of  whooping-cough,  but  I  have  no  experience  of 
it.  In  a  severe  case,  complicated  with  cj'anosis,  in  a  child  with  patent 
foramen  ovale,  Dr.  Mackey  used  the  remedy  with  apparently  good  result 
for  the  time;  the  degree  of  cyanosis  was  less  while  the  remedy  was 
taken,  and  the  attack  of  pertussis  ran  a  mild  course. 

PREPARATIONS  AND   DOSE. — rA   solution  containing  ten  volumes  of 
oxygen  is  the  one  recommended  by  Dr.  Richardson;  an  ethereal  solution 
is  preferred  by  others.     Dose:  of  the  former,  1  to  4  dr.  freely  diluted j  of 
the  ethereal  solution,  ^  to  2  dr. 
VOL.  I.— 2 


18  MATERIA   MEDIC  A    AND    THERAPEUTICS. 


CAKBO,  CHAECOAL,  C,  =  12. 

Carbon  is  very  widely  distributed  throughout  all  the  kingdoms  of 
nature  ;  the  diamond  represents  its  purest  condition,  crystallized  in  the 
form  of  a  regular  octahedron.  Plumbago,  or  graphite,  the  "  black  lead" 
of  our  pencils,  is  another  form  which  is  nearly  pure,  and  is  sometimes 
crystalline.  This  element,  combined  with  oxygen  and  various  earths  and 
minerals,  forms  carbonates,  as  chalk  and  limestone,  and  combined  with 
oxygen  it  occurs  as  carbonic  acid  in  the  air  and  in  many  mineral  waters. 
Two  varieties  of  carbon  are  now  officinal,  in  the  form  of  charcoal  prepared 
from  wood  and  from  bones. 

CARBO  L1GNI—WOOD   CHARCOAL. 

PREPARATION. — By  burning  wood  in  covered  heaps  or  in  closed  ves- 
sels, in  such  a  manner  as  to  almost  entirely  prevent  the  access  of  air. 
The  oxygen,  hydrogen,  and  nitrogen  of  the  vegetable  substance  are 
driven  off,  and  about  20  per  cent,  of  carbon  remains,  with  a  small  pro- 
portion of  earthy  salts — carbonates  of  potash  and  lime,  etc.  A  pure 
charcoal  may  be  obtained  from  the  combustion  of  oils  or  resins  with  in- 
sufficient oxygen,  and  is  known  as  lamp-black.  For  medicinal  use,  either 
kind  may  be  further  purified  by  ignition  in  a  closed  vessel  to  a  red  heat. 

CHARACTERS. — Wood  charcoal  occurs  as  a  black  powder,  or  in  black, 
brittle  pieces,  very  light,  and  retaining  the  shape  and  texture  of  the 
original  wood.  It  is  distinguished  from  purified  animal  charcoal  by 
leaving  a  bulky,_white  mineral  ash,  which  is  the  1  or  2  per  cent,  of  mineral 
salt. 

CARBO  AN1MAL1S-AN1MAL  CHARCOAL— BONE-BLACK. 

PREPARATION. — By  exposing  the  bones  of  animals  to  a  red  heat-with- 
out access  of  air.  Thus  prepared,  it  contains  10  to  20  per  cent,  of  char- 
coal, the  remainder  being  mostly  phosphate  and  carbonate  of  lime,  with 
some  iron  sulphuret.  It  may  be  obtained  from  any  animal  substance,  a 
good  quality  being  procured  from  dried  blood. 

CARBO  ANIMALIS  PURIFICATU8-PURIF1ED  ANIMAL    CHARCOAL. 

PREPARATION. — By  digesting  the  commercial  charcoal  with  dilute 
hydrochloric  acid  for  two  days  in  a  warm  place;  filtering,  washing,  drying 
the  residue,  and  igniting  in  a  closed  crucible.  By  these  processes  the 
salts  are  rendered  soluble,  and  removed  as  superphosphates  and  soluble 
chlorides,  while  carbonic  acid  and  sulphuretted  hydrogen  gases  are  driven 
off. 


CHARCOAL.  1 9 

CHARACTERS. — It  occurs  as  a  smooth,  black  powder,  which  has  no 
odor  and  scarcely  any  taste;  when  burned  it  leaves  very  little  ash.  Char- 
coal has  certain  chemical  and  mechanical  properties  which  are  very  useful 
in  pharmacy.  That  prepared  from  wood  is  used  as  a  deoxidizing  agent, 
as  in  the  preparation  of  sulphurous  from  sulphuric  acid  (by  distilling  the 
latter  with  it),  and  the  reduction  of  iodate  to  iodide  of  potassium.  Ani- 
mal charcoal  is  used  as  a  decolorizer  in  the  preparation  of  alkaloids,  etc. 
Its  power  in  this  respect  is  such  that  diluted  tincture  of  litmus  will  filter 
through  it  colorless.  Warrington  ascertained  that  it  would  remove  the 
bitterness  of  hops  and  other  vegetable  infusions,  and  Dr.  Garrod  soon 
afterward  pointed  out  that  it  would  destroy  the  activity  of  many  organic 
poisons,  as  opium,  aconite,  and  nux  vomica  (Lancet,  ii.,  1845).  Animal 
charcoal  is  much  more  powerful  as  an  antidote  than  that  prepared  from 
wood.  ' 

Both  varieties  possess  great  absorptive  power,  taking  up  more  than 
twice  their  weight  of  gases,  and  may  be  used  for  purifying  water  by  fil- 
tration, and  for  the  disinfection  of  sewer-emanations,  and  the  deodorizing 
of  sick-rooms,  dissecting-rooms,  etc.  (Letheby).  A  respirator  containing 
a  layer  of  charcoal  has  been  recommended  (Stenhouse,  Marcet). 

THERAPEUTICAL  ACTION"  (EXTERNAL). — Fetid  Discharges. — Charcoal 
is  used  in  surgery  to  cleanse  and  alter  the  condition  of  old  and  sloughing 
ulcers,  suppurating  sores  and  wounds,  and  is  sometimes  applied  directly 
to  them  in  the  form  of  powder,  or  poultice  with  bread;  to  relieve  offen- 
sive odors  it  is  better  enclosed  dry  in  muslin  bags  and  placed  near  the 
wounds.  In  open  cancer  a  paste  of  soot  with  glycerin  is  said  to  be  a  use- 
ful application  (Debreyne:  Medical  Times,  i.,  I860,  p.  402).  For  offen- 
sive perspiration  of  the  feet  or  axillae,  charcoal  may  be  mixed  with  alum 
or  zinc  oxide,  and  used  as  a  dusting  powder;  with  chalk  it  forms  a  cleans- 
ing dentifrice. 

CAUTERY. — Charcoal  "pegs"  have  been  used  as  a  cautery;  they  are 
mixed  with  nitrate  of  potash  (Lancet,  ii.,  1866,  309). 

THERAPEUTICAL  ACTION  (INTERNAL).  For  ordinary  medicinal  use, 
wood  charcoal  is  commonly  preferred. 

Dyspepsia,  Flatulence,  etc. — It  is  very  useful  for  patients  suffering 
from  pain,  weight,  and  sense  of  fulness  at  the  epigastrium  with  flatulent 
distention,  acidity,  sour  or  bitter  eructations,  nausea  or  vomiting,  furred 
tongue,  foul  breath,  and  with  a  tendency  to  loose,  ill-formed  motions. 
These  stomach  symptoms  are  usually  accompanied  with  palpitation. 

The  charcoal  powder,  which  acts  by  absorbing  intestinal  gases  and 
neutralizing  offensive  products  of  decomposition,  should  be  perfectly 
fresh  and  taken  dry,  and  preferably  at  the  commencement  of  a  meal. 
The  dose  need  not  be  so  large  as  a  teaspoonful,  which  is  commonly  given; 
in  many  cases  I  have  found  2  to  5  gr.  sufficient.  Bismuth  and  magnesia 
are  sometimes  advisable  at  the  same  time. 


20  MATERIA    MEDIC  A    AND    THERAPEUTICS. 

Diarrhea. — Charcoal  acts  well  in  the  diarrhoea  of  scrofulous  children 
•when  the  stools  are  small,  slimy,  and  light-colored,  with  intermediate 
troublesome  discharge  of  flatus  and  itching  of  the  anus;  also  when  the 
attacks  have  depended  upon  irritation  of  the  mucous  membrane  from  un- 
digested food,  etc.  It  may  be  well  given  with  milk  (of.  Medical  Record, 
March,  1881).  Rhubarb  is  often  usefully  combined  with  it  in  the  cases 
described. 

Charcoal  is  also  serviceable  in  the  atonic  irritative  diarrhoea  of  old 
people,  but  I  have  more  than  once  known  intestinal  hemorrhage  occur 
after  its  use.  If  large  quantities  be  given,  some  may  be  retained  and  act 
as  a  mechanical  irritant,  so  that  the  remedy  is  not  so  innocent  as  com- 
monly thought. 

Dysentery. — Charcoal  has  been  recommended  in  dysentery,  and  its 
antiseptic  powers  may  be  serviceable  in  chronic  cases.  The  pu-trid  smell 
of  the  discharges  may  certainly  be  relieved  by  a  few  doses  of  30  to  60 
gr.,  but  it  returns  on  discontinuance  of  the  remedy;  the  effect  is  a  tem- 
porary chemical  one. 

Dr.  Farre  has  reported  cases  in  which  it  has  acted  equally  well  when 
given  in  enema  (Ranking,  ii.,  1862). 

In  Enteric  Fever  charcoal  lessens  the  distention  of  stomach  and  intes- 
tines, and  when  mixed  with  magnesia  sometimes  proves  still  more  bene- 
ficial. 

Cancer  of  Stomach — Gastric  Ulcer. — In  these  organic  diseases  many 
of  the  distressing  symptoms  may  be  relieved  by  charcoal. 

Ascarides. — A  daily  dose  of  charcoal  mixed  with  salt,  and  given  in 
the  early  morning,  has  been  found  useful  in  destroying  and  preventing 
the  development  of  these  parasites. 

PREPARATIONS  AND  DOSE. —  Of  icood  charcoal,  many  varieties  are  in 
use,  some  practitioners  giving  the  preference  to  that  made  from  heavy 
woods  (box,  acacia,  etc.),  others  to  the  light  woods  (poplar  or  willow). 
Dr.  A.  Leared  recommended  that  made  from  "  vegetable  ivory."  Char- 
coal from  the  haematoxylon  campechianum  is  good,  but  has  been  over- 
praised. Belloc's  is  also  a  good  preparation;  it  is  made  from  poplar. 
Biscuits  and  lozenges  of  charcoal  are  also  used,  but  in  my  experience  are 
not  so  effective  as  the  powder,  and  they  sometimes  irritate  the  stomach. 
Carbo  ligni:  dose,  as  antacid,  antiseptic,  or  absorbent,  10  to  60  gr., 
or  more.  Cataplasma  carbonis  (*'  charcoal  poultice  ")  contains  £  oz.  of 
wood  charcoal.  Carbo  animalis  is  to  be  preferred  as  an  antidote  to 
poisons  :  dose,  from  -fa  oz.  to  2  oz.  or  more,  according  to  the  amount  of 
poison  swallowed  ;  it  is  best  taken  suspended  in  water.  Carbo  animalis 
purificatus  :  dose,  20  to  60  gr.  or  more. 

[PREPARATIONS,  U.  S.  P. —  Carbo  animalis,  Carbo  animalis purificat us, 
and  Carbo  ligni.] 


SULPHUR.  21 


SULPHITE,   S,=32. 

This  element  occurs  in  the  animal  kingdom  as  a  constituent  of  the 
albuminous  (protein)  tissues,  of  bile,  of  cystin,  etc.,  and  in  the  vegetable 
kingdom  in  many  essential  oils  and  resins,  such  as  those  of  mustard,  horse- 
radish, garlic,  and  asafcetida.  In  volcanic  districts  it  is  found  native,  and 
in  many  places  it  is  met  with  combined  with  metals,  as  sulphide,  or  "  py- 
rites ";  the  bisulphide  of  iron  contains  more  than  half  its  weight  of  sul- 
phur. United  with  hydrogen  or  with  alkalies,  it  is  found  in  many 
organic  substances  and  mineral  waters,  and  with  oxygen  it  forms  sulphuric 
acid  and  the  various  sulphates. 

CHARACTERS  AND  TESTS. — Sulphur  occurs  in  commerce  either  as  a 
gritty  powder,  or  in  round  sticks  (roll  sulphur — brimstone),  or  in  crystals; 
it  is  opaque  and  brittle,  pale  yellow  in  color,  of  insipid  taste,  and  emitting 
a  peculiar  odor  if  it  be  rubbed;  it  is  inflammable,  burning  with  a  bluish 
flame  and  evolution  of  sulphurous  acid  gas.  Sulphur  melts  at  115°  F. ; 
at  greater  heats  it  becomes  amber-colored,  then  brown,  and  gradually 
thickens  until  the  containing  vessel  may  be  inverted  without  spilling  it; 
it  is  insoluble  in  water,  slightly  soluble  in  alcohol  (absolute  alcohol  dis- 
solves nearly  1  per  cent.),  partially  soluble  in  fixed  and  volatile  oils  and 
bisulphide  of  carbon.  Hydrochloric  acid  added  to  sulphur  or  its  com- 
pounds causes  evolution  of  sulphuretted  hydrogen,  which  will  be  known 
by  its  characteristic  odor. 

OFFICINAL  FORMS. — Two  varieties  of  sulphur  are  placed  in  the  Phar- 
macopoeia— the  sublimed  and  the  precipitated. 


SULPHUR  SUBLIMATUM— SUBLIMATED  SULPHUR- 
FLOWERS  OF  SULPHUR. 

PREPARATION. — By  melting  or  burning  the  native  sulphur-earth,  or 
any  metallic  sulphide,  and  condensing  the  vaporized  sulphur  in  large 
chambers. 

CHARACTERS. — Sublimed  sulphur  is  a  gritty  powder,  canary-yellow  in 
color,  and  possessing  the  characters  of  the  element  as  already  described. 
It  may  be  acid  in  reaction  from  the  presence  of  a  little  sulphuric  acid,* 
formed  by  slow  oxidation,  and  should  be  freed  from  this  by  washing  with 
distilled  water,  after  which  it  becomes  "sulphur  lotum." 


SULPHUR  PR^GIPITATUM— PRECIPITATED  SULPHUR. 

Called  also  lac  sulphuris  (milk  of  sulphur),  though  this  name  was  ori- 
ginally given  to  an  old  preparation  made  with  lime  sulphate. 


22  MATERIA    MEDICA    AND    THERAPEUTICS. 

PREPARATION. — From  the  sublimed  sulphur,  by  first  boiling  it  with 
slaked  lime  until  the  substances  combine,  and  then  adding  hydrochloric 
acid,  which  unites  with  the  lime  while  the  sulphur  is  precipitated. 

The  reactions  are  somewhat  complex,  but  may  be  thus  represented: 
SCaH^+eS^SCaS^CaSJH^+SI^O  and  then,  on  adding  the  acid, 
2CaS5 + CaSaH,O4  +  6HC1 =3CaCl2 + 4Ha  O + 6S,. 

The  precipitated  sulphur  should  be  dried  at  a  heat  of  120°  F. 

CHARACTERS. — A  pure  specimen  is  of  pale  dead-yellow  color,  without 
odor  or  taste,  very  smooth  to  the  touch,  not  readily  diffused  in  water. 
Under  the  microscope  it  presents  opaque  rounded  granules,  separate  or 
in  clusters. 

[SULPHUR  LOTUM,  U.  S.  P. —  Washed  Sulphur. — Sublimed  sulphur, 
thoroughly  washed  with  water.  It  is  wholly  volatilized  by  heat,  and, 
when  moistened  with  water,  does  not  change  the  color  of  litmus.] 


SULPHIDES  OR  SULPHUEETS. 

Sulphurated  potash  (hepar  sulphuris,  or  "liver  of  sulphur")  (v.  Pot- 
ash) and  sulphide  of  calcium  (hepar  calcis,  or  "  liver  of  lime  ")  are  in  com- 
mon medical  use,  and  the  sulphides  of  sodium  and  of  ammonium  are 
found  in  many  of  the  sulphurous  mineral  waters.  Their  action  is  some- 
what similar  to  that  of  sulphur,  perhaps  more  powerful.  The  sulphide 
of  calcium  (not  officinal)  is  found  native,  or  may  be  prepared  artificially 
by  calcining,  in  a  closed  vessel,  equal  parts  of  sublimed  sulphur  and  pul- 
verized oyster-shell  (a  pure  form  of  lime  carbonate).  It  is  a  yellowish 
white  powder  of  sulphurous  taste  and  odor.  Jfypochloride  of  sulphur 
consists  of  "  flowers  of  sulphur "  impregnated  with  a  small  quantity  of 
chloride  of  sulphur  (SaCla)  obtained  by  passing  chlorine  over  sulphur.  It 
is  apt  to  explode  if  kept  in  full  glass  bottles  closely  corked. 

ABSORPTION  AND  ELIMINATION. — It  has  been  stated,  though  not  satis- 
factorily proved,  that  finely  divided  sulphur  may  pass  as  such  into  the 
blood.  Eberhard  states  further  that  he  has  seen  it  in  the  lymphatics,  and 
Griffith  that  he  has  found  it  excreted  in  the  urine,  but  these  statements 
lack  confirmation,  and  are  not  easy  of  credence. 

It  is  more  probable  that,  before  absorption,  under  the  influence  of 
alkaline  saliva  and  mucus,  and  the  secretion  of  intestinal  glands,  an  alka- 
line sulphide  is  formed,  part  of  which  is  decomposed  in  the  intestine  (the 
resulting  sulphuretted  hydrogen  being  passed  as  flatus),  and  part  oxidized, 
since  its  administration  increases  the  urinary  sulphates  (Regensburger: 
Centralblatt  f.  Med.,  1877).  Of  any  ordinary  dose  of  sulphur,  a  certain 
proportion  passes  out  unchanged  and  unabsorbed  in  the  fasces.  Fatty 
substances  are  said  to  promote  absorption  of  sulphur,  though  the  experi- 
ments of  A.  Krause  (1853)  scarcely  support  this  view.  He  found  that 


SULPHUR.  23 

•when  equal  doses  of  sulphur  were  given,  either  with  or  without  fat,  the 
amount  of  sulphates  excreted  by  the  urine  was  the  same. 

The  sulphuretted  hydrogen  which  is  absorbed  is  eliminated  by  the 
skin,  the  bronchial  membrane,  and  by  the  various  glands,  and  gives  indi- 
cation of  its  presence,  both  by  its  odor  and  by  staining  silver  articles 
worn  about  the  person.  Orfila  detected  it  in  the  urine. 

In  exceptional  cases  the  gas  may  be  formed  in,  and  absorbed  from, 
the  intestine  with  production  of  marked  but  temporary  nerve-depression. 
I  have  not  myself  seen  this  as  an  effect  of  taking  sulphur  medicinally, 
and  in  cases  where  sulphuretted  hydrogen  has  been  injected  into  veins 
it  has  been  so  quickly  eliminated  by  the  lungs  that  the  arterial  current 
remained  unaffected  by  it  (C.  Bernard).  Dr.  B.  W.  Richardson  conclud- 
ed, from  observations  with  "  sulphur  alcohol,"  that  its  compounds  were 
not  absorbed  from  the  alimentary  canal,  but  I  believe  that  occasionally 
they  may  be  so.  In  aged  persons,  and  in  some  cases  of  hepatic  and  in- 
testinal disorder,  I  have  noticed  attacks  of  depression  coincident  with 
flatulence  and  foul  breath,  and  relieved  by  a  stimulating  purge;  and  Dr. 
Senator  has  recorded  the  case  of  an  adult  suffering  from  gastric  catarrh, 
in  whose  breath  and  urine  sulphuretted  hydrogen  had  been  detected,  and 
who  had  more  than  one  attack  of  collapse  lasting  for  a  few  minutes  and 
accompanied  with  pallor,  giddiness,  and  small,  quick  pulse;  he  recovered 
after  purgation  (Berlin,  klin.  Woch.,  1868,  No.  24). 

PHYSIOLOGICAL  ACTION  (EXTERNAL). — Applied  with  friction  to  the 
sound  skin,  sulphur  causes  a  moderate  degree  of  irritation;  much  more 
if  the  surface  be  excoriated.  The  alkaline  sulphurets,  such  as  those  of 
potash  and  of  lime,  irritate  severely,  if  used  in  strong  and  warm  solution, 
to  a  delicate  skin.  Sulphur  and  some  of  its  compounds  have  the  power 
of  destroying  the  lower  forms  of  vegetable  and  even  animal  life;  whence 
their  practical  value  as  "  anti-zymotic  and  anti-parasitic  "  remedies.  Binz 
attributes  this  power  to  the  formation  of  sulphurous  acid  under  the  influ- 
ence of  exposure  to  the  air,  and  to  heat,  and  to  contact  with  protoplas- 
mic organisms  (e.g.,  the  oi'dium  Tuckeri  of  the  grape).  The  subject  of 
disinfection  is  more  fully  considered  under  the  heading  of  Sulphurous 
Acid. 

PHYSIOLOGICAL  ACTION  (INTERNAL). — Given  to  animals  it  produces 
at  first,  at  least,  some  stimulant  effect.  Benk  states  that  its  after-effect 
is  of  reverse  character,  and  that  this  is  accompanied  by,  and  is  probably 
due  to,  intestinal  irritation.  Hertwig  found  also  that  animals  were  read- 
ily brought  under  the  influence  of  the  drug  with  production  of  diarrhoea. 
Circulatory  System. — Sulphur  and  the  sulphides,  in  moderate  doses, 
stimulate  the  circulation,  especially  that  of  the  capillaries,  the  skin  and 
mucous  membrane,  and  the  venous  circulation  within  the  pelvis.  Con- 
gestive headache,  vertigo,  and  sometimes  hemorrhage  have  been  traced 
to  the  use  of  the  drug  and  of  mineral  waters  containing  it.  Gubler,  Mit- 


24  MATERIA    1IEDICA   AND    THERAPEUTICS. 

scherlich,  and  many  older  authorities  are  agreed  upon  these  points,  and 
assert  further  that  a  rise  in  temperature  and  distinct  pyrexia  may  be 
caused  by  sulphur,  especially  in  plethoric  persons. 

Secretion  and  Accretion. — Buchheim  and  some  modern  writers  express 
doubts  as  to  whether  sulphur  really  increases  secretion  from  the  bronchial 
mucous  membrane  and  the  skin;  but  I  cannot  agree  with  them,  for  I  have 
frequently  seen  an  augmentation  of  these  secretions  under  the  use  of  this 
remedy.  According  to  Boecker  the  urinary  water  and  solids  are  increased 
in  amount  under  the  action  of  sulphur,  but  this  requires  confirmation 
(Husemann). 

Cutaneous  System. — Some  dark  coloration  and  much  irritation  of  the 
skin  may  occur  from  the  internal  use  of  sulphur.  I  have  seen  a  red  pap- 
ular eruption  from  it,  and  also  occasionally  boils  and  carbuncles.  The 
waters  of  Harrogate,  Bareges,  Aix-la-Chapelle,  etc.,  have  been  known  to 
produce  such  effects. 

Digestive  System. — The  sulphides,  in  small  doses,  excite  a  sensation 
of  warmth  at  the  epigastrium;  in  excessive  doses,  they  may  cause  gastro- 
enteritis, and  even,  it  is  said,  "  insensibility  and  speedy  death  "  (Ringer). 
Sulphur  itself  in  small  doses  excites  a  similar  sense  of  warmth,  sometimes 
gaseous  eructations;  sulphurous  waters  in  the  quantity  of  several  ounces 
often  cause  pain  and  oppression  in  delicate  subjects.  Doses  of  20  to  40 
gr.  and  upwards  of  sulphur  in  powder  cause  moderate  stools,  semi-solid 
in  character,  and  passed  with  perceptibly  increased  peristaltic  action; 
hence,  it  has  been  presumed  that  the  muscular  coat  is  mainly  acted  upon. 
Sundeliri  maintained  that  sulphur  had  a  "  specific"  action  on  the  mucous 
coat,  but  we  cannot  speak  positively  about  this  (Biriz).  The  prolonged 
use  of  sulphur  as  an  aperient  induces  intestinal  catarrh. 

Husemann  supports  the  view  that  unabsorbed  sulphur  mechanically 
protects  the  intestinal  mucous  membrane  like  bismuth,  and  this  would 
explain  the  fact  that  large  doses  relax  without  colic,  while  moderate  doses 
relax  equally,  but  with  some  colic,  and  small  doses  cause  pain  without  the 
relaxation. 

SYNERGISTS. — As  a  stimulant,  sulphur  is  aided  in  effect  by  the  volatile 
oils;  as  an  alterative,  it  has  analogies  with  arsenic,  phosphorus,  and  pos- 
sibly iodine  (Gubler);  as  an  aperient,  magnesia  and  the  acid  tartrate  of 
potash  assist  its  action. 

Chemically,  sulphur  belongs  to  the  same  group  as  oxygen,  selenium, 
and  tellurium,  and  between  oxides  and  sulphides  there  is  much  analogy. 

ANTAGONISTS. — Sedatives,  refrigerants,  astringents,  and  cold  oppose 
the  ordinary  action  of  sulphur;  quinine  and  bromides  have  a  specially 
antagonistic  effect. 

THERAPEUTICAL  ACTION  (EXTERNAL). — Parasitic  Skin  Diseases — Sca- 
bies.— Sulphur  is  one  of  the  substances  which  are  fatal  to  acari,  and 
it  still  remains  one  of  the  best,  as  it  is  the  commonest,  remedy  for  sea- 


SULPHUR.  25 

bies,  though  Dr.  McCall  Anderson  and  others  have  objected  to  it  as  too 
irritant. 

It  is  nearly  certain  that  sulphur,  when  used  by  itself  or  mixed  with 
lard,  has  simply  a  mechanical  effect  on  the  epidermis;  but  when  carbonate 
of  potash  is  added  to  the  ointment,  sulphurated  potash  is  formed,  and 
this  compound  quickly  destroys  the  acari.  We  know,  from  clinical  ob- 
servation, that  these  insects  often  live  in  the  plain  sulphur  ointment  for 
several  days  without  much  apparent  detriment,  while,  as  Kuchenmeister 
says,  "  the  acari,  kept  in  a  solution  of  sulphurated  potash,  die  in  a  quarter 
of  an  hour." 

The  strength  and  the  frequency  of  the  application  should  be  varied 
according  to  the  delicacy  of  the  patient's  skin  and  the  amount  of  the 
eruption;  the  more  active  the  preparation,  and  the  more  thorough  its  use, 
the  quicker  will  be  the  cure.  Thus,  painting  the  body  with  a  solution  of 
chloride  of  sulphur  in  sulphuret  of  carbon  is  said  to  cure  in  five  minutes 
(Medical  Times,  i.,  1856,  pp.  247,  368);  while  Bourguignon's  formula  with 
lime  and  sulphur  (boiled  together)  is  allowed  half  an  hour,  and  M.  Hardy's 
method  with  soft-soap  frictions,  warm  bath,  and  anointing  with  2  parts 
of  sulphur  to  8  of  lard  and  1  of  potash  carbonate,  effects  its  purpose  in 
four  hours  (British  and  Foreign  Review,  ii.,  1852,  Le£ons);  but  such 
results  are  liable  to  be  accompanied  with  unnecessary  irritation  and  pain 
to  the  patient.  Dr.  Tilbury  Fox,  having  seen  eczematous  eruptions  and 
chronic  irritation  often  induced  by  the  excessive  use  of  too  strong  an 
ointment,  and  founding  his  advice  on  observation  of  the  parts  usually 
affected,  advocates  the  use  of  a  mild  ointment  (1  part  in  16,  i.e.,  %  dr.  to 
the  ounce  of  lard)  to  the  wrists  and  between  the  jingers  only,  in  acute 
cases  accompanied  with  general  irritation  (Lancet,  ii.,  1871);  but,  as 
Hebra  and  R.  Liveing  observe,  the  restriction  of  the  application  to  a,  few 
portions  needs  very  exact  diagnosis,  and,  as  a  rule,  the  ointment  of  the 
selected  strength  should  be  applied  to  every  part.  A  prolonged  warm 
bath  (half-hour),  and  thorough  cleansing  with  soap  and  friction,  should 
precede  the  inunction;  then,  after  drying,  either  the  mild  ointment  of 
Fox,  or  the  simple  ointment  of  the  Pharmacopoeia  (1  part  in  5),  or  one  of 
intermediate  strength  (1  part  in  8,  with  %  a  part  of  potash  carbonate) 
should  be  plentifully  rubbed  over  the  trunk  and  the  limbs,  especially  the 
flexor  side  of  the  limbs  and  between  the  fingers  and  toes;  and  then  socks, 
gloves,  drawers,  and  jersey  should  be  used  to  keep  the  ointment  in  con- 
tact with  the  skin  (Liveing).  An  ointment  I  commonly  prescribe  is 
made  with  sublimed  sulphur,  2  dr.;  sulphide  of  calcium,  ^  dr.;  and  simple 
ointment,  2  oz.  After  a  night's  application,  a  warm  bath  in  the  morning 
may  be  used  to  remove  the  odor  of  sulphur,  but  then  a  second  or  third 
inunction  may  be  required;  if  the  first  one  can  be  left  undisturbed  for 
twenty-four  hours,  it  will  often  suffice  to  cure.  In  some  cases,  a  lotion  of 
sulphuret  of  calcium  (liquor  calcis  c.  sulplmre)  acts  better,  because  it  is 


26  MATERIA    MEDICA    AND    TIIERAPEDTICS. 

more  thoroughly  applied  than  an  ointment;  its  use  should  also  be  pre- 
ceded by  a  warm  bath,  and  it  need  only  be  gently  applied  with  a  sponge 
or  brush;  if  used  with  friction  it  may  cause  very  severe  irritation. 

A  sulphur-ic^A  is  not  so  effacious  as  these  remedies,  but  may  some- 
times be  required,  and  may  be  made  with  half  a  pound  of  sulphurated 
potash  to  thirty  gallons  of  water — or  with  sulphur,  hyposulphite  of  soda, 
and  acid  (v.  Preparations).  Wooden  or  porcelain  vessels  should  be  used 
for  the  baths,  of  which  several  will  be  required.  Sulphur  in  vapor  may 
also  be  employed. 

It  is  important  to  remember  that  irritation  of  skin  may  remain  even 
after  the  scabies  itself  is  cured,  and  this  irritation  is  to  be  treated  by 
soothing  remedies;  sulphur  is  not  to  be  continued  longer  than  absolutely 
necessary  for  the  destruction  of  the  parasite.  Sometimes  it  may  be  alto- 
gether contraindicated,  or  may  be  inconvenient,  and  then  recourse  may  be 
had  to  styrax,  tolu,  petroleum,  or  iodide  of  potassium;  but  in  most  cases 
the  preceding  method  will  give  satisfactory  results. 

Tinea  Tonsurans — Chloasma. — The  parasites  in  these  maladies  are 
curable  by  sulphur  applications,  but  a  compound  ointment  containing 
ammoniated  mercury  acts  better  than  simple  sulphur  ointment  (Ung. 
hydrarg.  ammon.,  with  an  equal  part  of  Ung.  sulphuris,  is  a  good  for- 
mula). 

Sycosis  Mentagra  ("  JBarber's  Itch"). — In  this  disease  Hebra  advises 
that  the  affected  hairs  should  be  pulled  out,  and  then  a  paste  containing 
sulphur,  glycerin,  and  alcohol,  in  equal  parts,  should  be  rubbed  over  the 
diseased  skin  every  night  and  morning;  by  this  means  a  cure  is  rapidly 
effected,  but  it  is  rather  severe  treatment.  It  is  especially  adapted  for 
the  parasitic  form,  but  is  useful  also  in  the  more  common  one,  because 
sulphur,  as  well  as  sulphides,  lessens  pus-formations. 

Prurigo. — In  chronic  prurigo — especially  when  connected  with  phthei- 
riasis,  but  also  in  independent  forms — an  ointment  containing  sulphur 
with  a  preparation  of  tar  is  often  of  much  service.  Anderson  recommends 
6  dr.  of  pix  liquida  in  4  oz.  of  ordinary  sulphur  ointment  (Lancet,  ii., 
1869).  Sulphur  vapor  baths  are  useful.  In  ordinary  pruritus  1  find  a 
lotion  of  sulphurated  potash  very  effective  (v.  p.  34). 

Eczema — Psoriasis. — When  eczema  occurs  as  a  complication  of  sca- 
bies, Hebra  joins  with  the  sulphur  an  equal  quantity  of  tar  and  half  the 
quantity  of  chalk;  and  there  are  some  stages  of  idiopathic  eczema  when 
sulphur  acts  as  a  useful  stimulant,  viz.,  when  the  eruption  is  on  the 
decline,  but  remains  in  obstinate  chronic  patches,  especially  about  the 
legs.  It  acts  best  in  lymphatic  constitutions;  but,  as  a  rule,  I  prefer 
potash  or  tar  applications  to  sulphur.  I  may  say  the  same  as  to  my  own 
experience  in  chronic  psoriasis,  but  compound  sulphur  ointments  have 
been  found  useful  in  this  malady;  and  part  of  the  benefit  following  the 
use  of  caoutchouc  bandages  has  been  traced  to  the  sulphur  they  contain 


SULPHUR.  27 

(Hebra).  Dr.  Wetzler  states  that  ordinary  psoriasis,  when  not  much  de- 
veloped, can  be  cured  by  the  Aix-la-Chapelle  waters  alone,  if  prolonged 
baths  can  be  borne.  In  very  extensive  and  obstinate  cases,  however,  he 
adds  iodide  of  potassium  to  the  water,  and  prescribes  in  addition  sul- 
phurous vapor  baths,  tar-frictions,  etc.,  and,  it  is  stated,  with  the  best 
results  ("  Practical  Treatise,"  1862,  p.  66). 

Acne. — With  the  exception  of  scabies,  acne  is  the  skin  disease  in 
which  sulphur  is  most  frequently  used  and  gives  the  best  results;  the 
degree  of  stimulus  or  irritation  supplied  by  it  seems  more  appropriate 
than  that  of  any  other  application,  unless  it  be  sometimes  mercury.  In 
the  simple  acne  of  young  people,  occurring  in  the  sebaceous  glands  about 
the  face  and  shoulders,  accompanied  by  comedo  and  without  much  general 
congestion,  a  fairly  strong  preparation  may  be  used,  such  as  the  sulphur 
ointment  of  the  Pharmacopoeia;  or  potash  may  be  added  to  it  (Lancet, 
ii.,  1878),  or  a  lotion  containing  6  dr.  of  precipitated  sulphur  and  1  dr.  of 
glycerin,  with  6  oz.  of  rectified  spirit  (Anderson).  When  a  moderate 
degree  of  irritation  is  present  the  proportions  may  be  altered;  thus,  1  dr. 
of  sublimed  sulphur  may  be  rubbed  up  with  a  little  alcohol,  and  then  2 
dr.  of  the  smoother  variety  may  be  added,  with  water  to  dilute  sufficiently 
(Morris:  Lancet,  i.,  1855);  or  a  lotion  that  I  commonly  use  with  advan- 
tage is  made  with  2  to  4  dr.  of  precipitated  sulphur,  with  the  same  quan- 
tity of  spirit  and  glycerin,  in  6  oz.  of  rose-water.  Spirits  of  camphor  or 
ether  may  be  added,  to  relieve  itching  or  heat,  and  special  indications 
for  internal  treatment  must  be  considered.  Sometimes  dusting  with 
the  pure,  dry  precipitated  sulphur  answers  better  than  anything  (Par- 
sons: British  Medical  Journal,  i.,  1879).  The  local  remedies  should  be 
lightly  or  firmly  applied,  according  as  they  can  be  borne,  left  in  contact 
all  night,  and  washed  off  with  mucilaginous  decoctions  or  water  in  the 
morning. 

For  acne  rosacea,  one  of  the  best  applications  is  an  ointment  contain- 
ing 2  dr.  of  the  hypochloride  of  sulphur  in  the  ounce  of  rumex  ointment 
(Wilson),  or  a  lotion  of  £  oz.  of  sublimed  sulphur  in  4  oz.  of  elderflower 
water.  The  ointment  of  iodide  of  sulphur,  which  is  still  stronger,  may 
be  carefully  used  to  chronic  cases  of  any  form  of  acne.  A  certain  amount 
of  temporary  irritation  must  be  expected  from  these  remedies,  and  may 
require  their  occasional  intermission  and  the  use  of  sedatives;  but  some 
compound  of  sulphur,  judiciously  employed,  will  be  found  the  most  effec- 
tive cure.  The  internal  use  of  calcium  sulphide  should  be  conjoined  with 
this  treatment. 

Burns — Scalds. — Dr.  Myrtle,  of  Harrogate,  has  recommended  sulphur 
ointment  as  a  good  application  for  burns  and  scalds  (Edinburgh  Medical 
Journal,  1862). 

Granular  Ophthalmia. — Wharton  Jones  has  found  advantage  from 
the  use  of  sulphur  ointment  as  a  stimulant,  a  small  quantity  being  applied 


28  MATE1UA    MEDICA    AND    THERAPEUTICS. 

between  the  lids  at  bedtime  (Medical  Times,  i.,  1859).  There  are,  how- 
ever, better  applications  than  this. 

Rheumatism. — The  friction  of  rheumatic  limbs  with  sulphur  is  as  an- 
cient at  least  as  Pliny  (lib.  xxxv.),  and  attention  was  specially  directed 
to  it  again  some  years  ago  by  Dr.  Fuller,  Dr.  O'Connor,  and  others  (Med- 
ical Times,  i.,  1858).  They  found  it  useful  also  in  sciatica  and  lumbago, 
adding  to  the  frictions  close  and  constant  covering  with  flannel.  Renard 
found  it  very  serviceable  in  rheumatism  affecting  tendinous  parts,  in  his 
own  person,  after  an  acute  attack;  it  produced  some  degree  of  heat  and 
increase  of  perspiration  when  it  acted  well.  It  should  certainly  be  tried 
in  all  obstinate  forms  of  rheumatism,  and  especially  that  form  which  at- 
tacks the  soles  of  the  feet  in  those  who  are  exposed  to  damp  and  cold. 

It  is  in  the  different  forms  of  chronic  rheumatism  and  chronic  skin 
disease  that  baths  of  sulphurous  waters,  as  at  Bareges  arid  Aix-la-Cha- 
pelle,  are  found  most  valuable. 

THERAPEUTICAL  ACTION  (INTERNAL). — The  therapeutical  action  of  sul- 
phur and  the  sulphides  is  somewat  similar,  but  the  former  is  commonly 
used  in  small  doses  to  produce  an  "alterative,"  and  in  large  doses  a  laxa- 
tive effect,  and  the  latter  to  modify  some  acute  conditions,  especially 
when  they  are  connected  with  suppuration  in  various  stages. 

Skin  Disease. — The  internal  use  of  sulphur  for  many  skin  diseases 
rests  on  an  old  tradition,  but  is  not  much  adopted  in  modern  practice.  I 
have  tried  it  extensively,  and  although  the  alkaline  sulphurous  waters  are 
useful  sometimes,  and  in  acne  rosacea  the  calcium  sulphide,  in  ^  to  ^  gr. 
doses  thrice  daily,  seems  to  help  absorption  of  the  tubercles  and  abate 
venous  hypersemia,  yet,  with  these  exceptions,  I  have  not  seen  much  ad- 
vantage. Dr.  Cane  refers  to  sixteen  cases  of  acne  in  which  the  last-named 
remedy  was  useful  (Lancet,  ii.,  1878). 

Scrofula — Swollen  Lips,  Glands,  etc. — Scrofulous  children  are  often 
disfigured  by  a  chronic  swelling  of  the  upper  lip  and  alee  nasi,  which  may 
be  connected  with  a  crack  or  fissure  on  the  inner  surface  of  the  mucous 
membrane.  Accompanying  this  condition,  there  often  exists  a  tendency 
to  dyspepsia  and  indolent  swelling  of  the  mesenteric,  cervical,  and  other 
glands. 

Although  we  cannot  wholly  cure  the  constitutional  tendency  in  such 
cases  by  sulphide  of  calcium,  yet  I  have  seen  their  general  condition 
greatly  improved  by  small  doses  (£  gr.)  given  night  and  morning  for  a 
few  weeks;  the  fissure  has  healed  and  the  lip-swelling  subsided,  and  the 
glands  have  grown  less. 

In  cases  where  pus  has  actually  formed  in  some  of  the  glands,  the 
effects  of  this  remedy  may  readily  be  traced  in  the  subsidence  and  disap- 
pearance of  some  of  the  swellings,  while  others  progress  quickly,  matu- 
rate and  discharge,  and  others  that  have  been  open  and  discharging  un- 
healthily for  some  time  take  on  healthy  action,  and  ultimately  contract 


SULPHUR.  29 

and  heal.  For  permanent  good  results  this  treatment  should  be  followed 
up  by  cod-liver  oil  and  generous  diet,  and,  if  possible,  change  to  the  sea- 
side. As  a  rule,  frequent  doses  of  the  sulphide  are  not  desirable,  as  they 
are  apt  to  derange  the  stomach  and  cause  troublesome  eructation  of  sul- 
phuretted hydrogen. 

Scrofulous  Ophthalmia,  etc. — In  this  affection  I  can  recommend  sul- 
phide of  calcium,  and  especially  when  ulceration  of  the  cornea  is  pres- 
ent; it  also  acts  well  in  scrofulous  otorrhcea,  and  indeed  in  almost  all 
purulent  discharges  occurring  in  children,  especially  when  becoming  fetid 
and  obstinate  in  character. 

Suppuration. — Calcium  sulphide  exerts  a  marked  influence  on  the 
formation  of  pus.  If  given  early,  it  controls  the  inflammatory  process, 
either  aborting  it  so  that  it  does  not  go  on  to  suppuration,  or,  if  this  take 
place,  controlling  and  limiting  its  extent,  promoting  a  more  healthy  for- 
mation, quicker  evacuation,  and  more  rapid  subsequent  healing. 

In  the  treatment  of  simple  abscess  I  have  frequently  used  it  with  much 
advantage;  in  tonsillar  abscess  (quinsy)  it  is  particularly  valuable,  and 
may  save  recourse  to  incision;  and  in  mammary  abscess,  if  the  time  for 
belladonna  or  antimony  is  past,  the  sulphide  is  quite  the  best  remedy. 
It  has  seemed  to  me  to  check  the  spread  of  the  inflammation,  and  to  help 
quickly  to  evacuate  matter,  and  so  shorten  the  tedious  course  common  in 
this  malady.  Should  hardness  and  pain  continue  after  an  opening  has 
formed,  and  should  the  discharge  come  away  incompletely,  the  remedy 
must  still  be  continued,  and  is  likely  to  exert  a  favorable  influence. 

In  bubo,  especially  if  indolent,  and  with  scanty,  unhealthy  pus-forma- 
tion, the  sulphide  will  often  determine  a  more  healthy  action;  ^  to  ^  gr. 
iu  pill  every  three  or  four  hours  is  a  suitable  dose. 

In  ordinary  boils,  and  in  carbuncles  also,  a  compress  moistened  with 
sulphide  of  calcium  lotion — (4  gr.  to  the  pint  of  water) — should  be  ap- 
plied. When  eruptions  of  boils  recur  at  intervals,  I  commonly  advise  a 
course  of  the  precipitated  sulphur — 5  to  10  gr.  night  and  morning — for 
several  weeks  during  the  intervals,  but,  at  the  time  of  actual  maturation, 
recommend  the  sulphide  as  acting  more  quickly.  Even  in  pneumonia,  in 
those  exceptional  cases  when  the  exudation  in  later  stages  degenerates 
into  pus,  I  have  seen  benefit  from  the  same  remedy;  it  has  equally  seemed 
to  assist  evacuation  of  matter  already  formed,  and  to  check  the  tendency 
to  its  fresh  formation. 

Syphilis. — In  most  of  the  later  manifestations  of  this  disorder,  sul- 
phurous waters  have  a  good  reputation,  but,  in  my  opinion,  without  suffi- 
cient reason.  At  Aix-la-Chapelle,  for  instance,  the  treatment  is  conduct- 
ed mainly  by  mercurial  inunction,  and  the  sulphur-waters  used  locally  and 
internally,  can  only  b^considered  adjuvants  to  this  more  powerful  remedy. 
I  think  they  serve  mainly  to  cleanse  and  stimulate  the  skin,  to  regulate 
the  action  of  the  bowels  and  viscera,  and  to  counteract  any  injurious  ef- 


30  MATERIA   MEDICA    AND   THERAPEUTICS. 

fects  that  might  arise  from  the  mercury  (v.  p.  170).  They  have,  perhaps, 
a  further  use  for  diagnostic  purposes,  since  it  is  said  that  obscure  symp- 
toms really  due  to  old  or  latent  syphilis  manifest  themselves  more  fully 
under  a  course  of  the  waters,  and  thus  give  the  necessary  indications  for 
treatment  by  iodides  or  mercury.  Dr.  Wetzler  gives  several  instances 
of  this  (op.  cit.),  and  I  have  no  doubt  of  its  possibility. 

I  must  say  also  that  I  have  seen  advantage  from  the  use  of  sulphide 
of  calcium  in  sypMKtic  laryngitis,  notably  when  mercury  had  been  pre- 
viously taken  to  saturation. 

Diphtheria. — During  certain  stages  of  this  malady,  preparations  of 
aconite,  iron,  iodine,  bromine,  etc.,  are  indicated,  as  described  under  those 
medicines;  but  at  the  time  when  pus  is  commencing  to  form,  and  the 
false  membrane  is  becoming  somewhat  loosened  from  the  mucous  surface, 
the  sulphide  of  calcium  is  often  useful,  for  it  exerts  the  action  already 
referred  to,  of  assisting  to  healthy  completion  and  at  the  same  time  limit- 
ing the  extent  of  the  suppurative  process.  We  know  that  this  formation 
of  pus-cells  occurs  as  part  of  the  diphtheritic  inflammation  before  the  re- 
turn of  healthy  conditions,  and,  as  remarked  by  Mackenzie  (who  does  not, 
however,  mention  this  remedy),  "when  it  is  found  impossible  to  check 
the  formation  of  lymph,  it  is  rational  treatment  to  convert,  as  far  as  we 
can,  the  inflammatory  into  a  suppurative  process  "("On  Diphtheria," 
1879).  If  commenced  early  in  this  stage,  in  doses  of  -fa  to  £  gr.  every 
one  or  two  hours,  it  produces  the  best  effects;  but  it  is  useful  also  even  if 
begun  after  pus-formation  is  fully  developed,  and  I  believe  it  has  some 
influence  in  lessening  blood-poisoning.  The  value  of  steam-inhalation  in 
helping  on  the  natural  changes  of  diphtheria  and  the  formation  of  muco- 
pus  and  loosening  of  the  membranes  has  been  often  proved  (P.  James, 
Oertel),  and  is  now  well  known.  I  find  it  still  more  efficacious  if  the  sul- 
phide of  calcium  be  added  to  the  boiling  water  in  the  proportion  of  about 
4  gr.  to  the  pint,  so  that  a  certain  amount  of  sulphurous  vapor  is  locally 
applied. 

The  local  insufflation  of  finely  powdered  sulphur  has  been  credited  with 
arresting  the  development  of  diphtheritic  exudation  (Practitioner,  Novem- 
ber, 1868,  vi.),  but  has  disappointed  expectation.  Oertel  concludes,  after 
much  experience,  that  it  acts  only  as  a  "  scouring  powder,"  wearing  off 
the  membranes  by  friction;  it  has  no  influence  at  the  onset  of  the  malady, 
but  has  seemed  to  answer  only  when  purulent  infiltration  and  fibrinous 
exudation  have  already  ceased.  It  has  an  antizymotic,  but  no  other  speci- 
fic power,  and  is  liable  to  cause  irritation  (British  Medical  Journal, 
January  11,  1879). 

Mr.  Erskine  Stuart  has,  however,  written  still  more  recently  in  favor 
of  local  applications  of  precipitated  sulphur.  According  to  his  latest  ex- 
perience, "  it  is  best  applied,  after  being  rubbed  up  with  a  little  water,  on 
a  swab  to  the  affected  part;  it  is  free  from  grittiness,  it  sticks  better,  and 


SULPHUR.  31 

hence  exerts  its  action  for  a  longer  time,  and  is  applied  more  safely  in 
this  manner  than  by  insufflation."  He  states  "  that  every  case  treated 
with  sulphur  made  a  rapid  recovery  "  (Practitioner,  October,  1879),  but 
the  number  apparently  is  not  more  than  six,  and  he  unduly  depreciates 
other  remedies. 

In  Laryngo-tracheal  Diphtheria  ( Croup),  when  we  cannot  always  see 
the  false  membrane,  I  find  the  sulphide  of  calcium  treatment  indicated  if 
wheezing,  rattling  sounds  accompany  the  breathing,  i.e.,  when  the  mem- 
brane begins  to  be  loosened,  rather  than  in  the  first  stage,  when  the 
breath-sounds  are  of  dry  and  sawing  character. 

Chronic  Sore  Throat. — Dr.  Gueneau  de  Mussy  has  specially  pointed 
out  the  value  of  sulphur  waters  in  "  glandulous  angina,"  which,  under  or- 
dinary treatment,  is  an  obstinate  malady.  The  waters  of  Eaux  Bonnes 
are  of  remarkable  efficacy  in  such  cases  (v.  Mineral  Waters);  the  sulphu- 
rous acid  spray  is  also  useful  if  not  too  irritating. 

Scarlet  Fever. — Mr.  Pigeon  believes  that  in  sulphur  he  has  found  the 
true  remedy  for  this  fever,  and  he  certainly  applies  it  very  thoroughly, 
and  appears  to  have  had  good  success.  He  anoints  the  patient  twice 
daily  with  sulphur  ointment,  gives  5  gr.  of  sulphur  by  the  mouth  twice 
daily,  and  fumigates  frequently  with  sulphur  vapor  (Lancet,  ii.,  1876). 

Variola. — Sulphide  of  calcium,  I  believe,  often  moderates  excessive 
suppuration  in  this  malady. 

Asthma —  Chronic  Bronchitis. — In  cases  with  much  cough  and  profuse 
secretion,  sulphur  will  often  relieve,  lessening  and  modifying  the  expec- 
toration. I  have  seen  this  accomplished  in  many  instances.  The  old 
physicians  described  it  as  "  balsamum  pectoris,"  and  it  still  forms  part  of 
some  quack  "nostrums."  Dr.  Graves  records  his  experience  in  its  favor. 
Binz  suggests  that  sulphuretted  hydrogen,  being  excreted  by  the  bronchial 
mucous  membrane,  may  partially  narcotize  the  terminals  of  irritated  bron- 
chial nerves,  and  advocates  for  the  continued  use  of  small  doses  of  sul- 
phur in  asthma  are  not  wanting  (Duclos:  Bulletin,  1SG1).  I  have  seen 
cases  marked  by  loud  wheezing,  profuse  but  difficult  expectoration, 
troublesome  palpitation,  and  nocturnal  spasms  of  severe  dyspnoea,  improve 
quickly  with  5  to  10  gr.  of  sulphur  taken  thrice  daily.  The  sulphur 
springs  of  Weilbach  are  celebrated  for  relieving  cases  of  chronic  bronchi- 
tis, especially  when  complicated  with  haemorrhoids. 

Phthisis. — Sulphur  was  well  known  to  the  ancients  as  a  remedy  in 
consumption,  and  Galen  ordered  to  phthisical  patients  inhalation  of  the 
vapor  from  the  crater  of  Etna.  It  is  not  much  used  internally  in  modern 
practice,  but  for  chronic  phthisis  the  springs  at  Weilbach  have  a  favor- 
able reputation. 

Sutro  finds  sulphur  of  good  service  in  some  cases  of  phthisis,  and  the 
presence  of  haemorrhoids  is  one  indication  for  it;  he  suggests  that  it  com- 
bines with  the  iron  of  effete  blood-corpuscles,  quickens  the  elimination  of 


32  MATERIA    MEDICA    AND    THERAPEUTICS. 

this  and  other  residua,  and  thus  relieves  the  portal  system  and  indirectly 
the  lungs  (Medical  Times,  i.,  1862,  p.  362),  and  I  quite  agree  with  those 
observers  who  have  noted,  in  this  disease,  much  advantage  from  the  use 
of  sulphur  both  internally  and  by  inhalation.  Dr.  Devvar  relates  instances 
where  sulphurous  acid  and  steam  acted  .unexpectedly  well  on  phthisical 
subjects  exposed  to  them  (Medical  Times,  i.,  1867).  A  spray  containing 
sulphurous  acid  facilitates  expectoration,  and  also  disinfects  and  lessens 
purulent  secretion,  and  so  far  relieves  certain  symptoms,  but  has  no  speci- 
fic power  over  the  disease. 

Chrome  Rheumatism. — Sulphur  frictions  for  rheumatism  have  been 
already  mentioned,  and  the  drug  was  formerly  considered  a  good  internal 
remedy  for  chronic  muscular  and  articular  pain,  and  no  doubt  it  is  often 
of  real  value  when  given  in  doses  of  from  5  to  20  gr.  twice  daily  for  some 
time — I  think  the  smaller  doses  give  the  better  results.  Remedies  calcu- 
lated to  produce  diaphoresis,  such  as  vapor-baths,  should  be  generally 
combined  with  its  use.  In  acute  articular  rheumatism  it  has  little  or  no 
power. 

Paralysis. — In  chronic  and  asthenic  cases  of  impaired  motor  power, 
the  use  of  sulphur  internally  and  externally  deserves  a  fair  trial.  Dr. 
Graves  was  accustomed  to  depend  upon  it  after  a  course  of  strychnia. 
Wetzler  has  recorded  four  cases  of  progressive  muscular  palsy  benefited 
by  warm  sulphur-baths  and  the  administration  of  the  water  at  Aix-la- 
Chapelle  (British  and  Foreign  Review,  ii.,  1856,  p.  457),  and  in  his 
treatise  (1862)  has  added  several  other  cases.  Althaus  found  these  reme- 
dies useful  in  locomotor  ataxy  (Lancet,  ii.,  1865).  I  have  also  seen  some 
advantage  from  them  in  the  latter  condition. 

Mercurial  Tremor — Mercurialism. — In  cases  of  palsy  and  tremor  con- 
nected with  the  action  of  mercury,  sulphur  is  useful  (Lettsom)  and  de- 
serves trial;  it  is  said  also  to  neutralize  acute  mercurialism  accompanied 
with  salivation,  etc.,  and  may  be  given  in  5  to  10  gr.  doses  at  the  same 
time  as  chlorate  of  potash.  On  the  other  hand,  in  patients  who  have 
taken  mercury  at  some  previous  period,  sulphur,  like  iodides  and  other 
powerful  alterants,  has  sometimes  determined  a  fresh  salivation. 

Lead-  Colic — Lead-Palsy. — In  these  conditions  sulphur  has  been  found 
available,  though  iodide  of  potassium  is  now  proved  to  be  better.  In  an 
epidemic  of  lead-poisoning  at  Havre,  M.  Marguerette  found  sulphur  give 
much  relief;  it  required  to  be  exhibited  at  first  in  very  large  doses  (50 
grammes  in  the  first  day),  being  afterward  gradually  diminished  as  the 
symptoms  improved  (Bulletin,  October,  1867). 

Hepatic  Disease. — Chronic  enlargement  of  the  liver,  with  obstruction 
to  the  portal  circulation,  accompanied  as  it  usually  is  by  haemorrhoids^  is 
often  much  benefited  by  a  course  of  sulphur,  or  of  calcium  sulphide,  or 
potassium  sulphide. 

Constipation — hemorrhoids. — The  mild  action  of  sulphur  on  the  mu- 


SULPHUR.  33 

cous  membrane,  or  muscular  coat  of  the  intestine,  renders  it  a  useful  ape- 
rient for  children  and  delicate  persons,  especially  if  there  be  congestion 
about  the  rectum  or  pelvic  viscera.  In  cases  of  haemorrhoids  it  is  one 
of  the  best  laxatives,  and  if  not  powerful  enough  may  be  combined  with 
tartarated  potash,  or  with  confection  of  senna.  A  "  compound  liquorice 
powder,"  in  which  sulphur  is  the  main  ingredient,  has  recently  been  intro- 
duced into  the  British  Pharmacopoeia,  but  the  Prussian  formula,  which  in- 
cludes also  finely  powdered  senna,  is  superior.  In  the  treatment  of  piles, 
sulphur  need  not  be  given  in  quantity  sufficient  to  produce  a  laxative 
effect,  unless  this  is  otherwise  required,  for  it  can  relieve  by  virtue  of  a 
stimulant  and  tonic  action  on  the  venous  and  capillary  circulation,  es- 
pecially of  the  rectum  and  pelvic  viscera,  without  any  direct  aperient 
action.  The  ordinary  dose  should  be  5  to  10  gr.  morning  and  night. 
Weak  sulphur  ointments  locally  applied  increase  the  good  result.  The 
remedy  may  also  be  used  in  the  form  of  vapor,  and  if  the  fumes  from 
burning  sulphur  can,  by  means  of  apparatus,  be  applied  directly,  they 
often  relieve  congested,  painful,  bleeding  piles;  this  is  a  popular  domestic 
"  cure  "  in  some  parts  of  the  country  (Pairman).  Dr.  Thorowgood  attri- 
butes to  sulphur  a  special  value  in  torpor  of  the  colon,  which  often  causes 
or  complicates  dyspepsia;  he  recommends  10  to  20  gr.  to  be  taken  in  the 
early  morning  with  nux  vomica;  the  lozenges  of  Holsverck  contain  the 
same  ingredients  (Lancet,  i.,  1869;  Medical  Times,  i.,  1858,  p.  457). 

Diarrhoea  —  Dysentery — Cholera. —  Dr.  Blacklock,  of  the  Madras 
army,  and  Dr.  Graves  quote  an  extensive  experience  in  favor  of  the  effi- 
cacy of  sulphur  in  these  maladies;  the  latter  observer  combines  it  with 
soda  and  spirits  of  lavender,  and  in  severe  cases  with  opium  ("  On  Chol- 
era," 18G5).  Mr.  Prosser  also  finds  drachm  doses  given  with  mucilage  to 
be  "one  of  the  best  remedies  in  epidemic  diarrhoea  and  cholera,"  (Lan- 
cet, ii.,  1866,  p.  483).  This  is  not  a  general  experience,  nor  is  it  mine, 
although  I  have  found  sulphur  in  2  or  3  gr.  doses  useful  in  the  fetid, 
watery  diarrhoea  of  scrofulous  children,  and  in  some  cases  of  chronic  dys- 
enteric diarrhoea  with  tenesmus. 

Disorders  of  Menstruation. — When  the  menses  are  delayed  in  weakly 
and  phlegmatic  persons,  sulphur  used  as  an  habitual  laxative  has  some 
influence  in  bringing  on  the  flow;  on  the  other  hand,  it  has  been  recom- 
mended for  relieving  uterine  congestion  and  its  consequences  at  the  cli- 
macteric period  (Tilt). 

Ascaris  Vermicular  is. — Precipitated  sulphur  is  often  a  simple  and 
efficient  remedy  for  these  parasites;  5  to  10  or  15  gr.  should  be  given 
daily,  morning  and  night,  for  some  weeks. 

PREPARATIONS  AND  DOSES. — Pure  precipitated  sulphur  is  more  fia-ely 

divided,  and  is  thought  to  be  more  active,  than  the  sublimed  form;  the 

dose  of  either  is,  however,  the  same,  5  to  10  gr.  as  a  stimulant,  20  to  60 

gr.  as  a  laxative;  it  is  well  given  in  milk,  honey,  or  treacle.      Conffictio 

VOL.  I.— 3 


34  MATEKIA   MEDICA    AND    THERAPEUTICS. 

(made  with  sublimed  sulphur):  dose,  60  to  120  gr.  Unguentwn  contains 
1  part  to  4  of  benzoated  lard.  A  milder  and  often  more  useful  form  of 
ointment  is  made  with  half  the  amount  of  sulphur  and  ^  dr.  of  carbonate 
of  potash  to  the  ounce  ;  essence  of  lemon  conceals  the  odor  (Squire). 
iSolutio  colds  c.  sulphure  may  be  prepared  by  boiling  together  1  oz.  of 
quick-lime  and  5  of  sublimed  sulphur  in  1  pint  of  water  for  half  an  hour* 
tilter,  and  make  up,  if  necessary,  to  half  a  pint;  a  similar  solution  is  now 
commonly  sold  by  wholesale  chemists.  >  Lotto  potassce  sulphurates  rnav 
be  prepared  with  1  dr.  to  half  a  pint  of  water  for  use  in  irritable  skin 
eruptions.  Balneum  potassce  sulphurates :  %  Ib.  to  30  gallons  of  water, 
in  porcelain  or  wooden  vessel.  Balneum  sulphuris  comj)ositum  (Star- 
tin):  precipitated  sulphur,  2  oz. ;  hyposulphite  of  soda,  1  oz. ;  dilute  sul- 
phuric acid,  %  fl.  oz.;  water,  1  pint:  to  be  added  to  30  gallons  of  water. 
A  sulphur  vapor  bath  may  be  prepared  by  evaporating  %  oz.  to  2  oz.  of 
the  solution  of  lime  and  sulphur  by  means  of  a  spirit-lamp  placed  under 
a  suitable  arrangement  of  chair,  coverings,  etc. ;  the  face  should  be  pro- 
tected from  the  vapor  (Medical  Times,  i.,  1870,  p.  308). 

[PREPARATION,  U.  S.  P. —  Unguentum  Sulphuris:  sublimed  sulphur, 
1  troyounce;  lard,  2  troyounces.] 

ADULTERATIONS. — The  precipitated  sulphur  commonly  sold,  especially 
before  the  passing  of  the  Adulteration  Act,  contained  a  large  proportion 
of  sulphate  of  lime;  this  was  due  to  the  employment  of  sulphuric  acid 
instead  of  the  hydrochloric  acid  ordered  in  the  Pharmacopoaia;  but,  as 
some  excuse,  it  may  be  mentioned  that  a  former  London  Pharmaco- 
posia  contained  a  preparation  made  with  sulphuric  acid,  and  known  as 
"milk  of  sulphur."  This  name  has  now  been  transferred  as  a  synonym 
to  the  modern  "precipitated  sulphur,"  and  hence  has  arisen  much  confu- 
sion and  even  litigation.  Druggists  have  been  prosecuted  for  supplying 
the  lime  compound  when  asked  for  "  milk  of  sulphur,"  and  although  con- 
victed by  some  magistrates  of  offences  against  the  Act,  the  convictions 
have  mostly  been  quashed  on  appeal  to  a  higher  court,  on  the  ground 
that  "milk  of  sulphur"  is  known  by  trade  custom  to  be  a  distinct  thing 
from  the  pure  precipitated  form.  It  is  desirable  that  this  should  be  par- 
ticularly understood  (British  Medical  Journal,  i.,  1877;  Lancet,  i.,  1876, 
p.  936).  As  a  rule,  a  pure  preparation  may  be  obtained  by  asking  for 
that  of  the  British  Pharmacopoeia.  An  adulterated  specimen  is  whiter, 
with  only  slight  yellowish  tinge,  and  when  pressed  looks  silky  and  glis- 
tening; under  the  microscope,  crystals  may  be  seen  in  thin  tables  or 
elongated  prisms,  and  on  exposure  to  a  red  heat,  lime  is  left  as  a  white 
ash  (Medical  Times,  i.,  1853).  Washed  Sicilian  sulpnur  is  nearly  always 
pure,  but  that  prepared  from  pyrites  often  contains  arsenic. 


PHOSPHORUS.  35 


PHOSPHOKUS,  P,=31. 

This  non-metallic  element  was  obtained  in  the  seventeenth  century 
from  the  urinary  phosphates,  by  German  chemists,  and  by  Dr.  Boyle  in 
this  country.  London  was,  for  some  time,  the  principal  place  of  its 
manufacture,  so  that  it  became  known  as  "phosphorus  anglicanus."  It 
occurs,  variously  combined,  in  certain  especially  fertile  soils,  in  the  seeds 
of  vegetables,  and  in  the  nerve-tissue  and  bone  of  animals  (particularly 
when  young),  as  well  as  in  the  blood  and  the  urine. 

PREPARATION.  —  It  is  now  procured  from  bone-ash  (os  ustum)  by  di- 
gesting it  in  sulphuric  acid,  and  then  distilling  with  charcoal. 

The  contained  phosphate  of  lime  is  partially  changed  into  superphos- 
phate and  metaphosphate:  phosphorus  distils  over,  and,  by  a  further  pro- 
cess of  purifying,  is  obtained  as  a  colorless,  oily  liquid,  which  solidifies 
in  cakes,  or  in  rounded  hollow  pencils,  according  to  the  shape  of  the  glass 
moulds  employed.  The  last  part  of  the  process  may  be  represented  thus: 


CHARACTERS.  —  The  cakes  or  pencils  are  colorless,  waxy,  and  translu- 
cent when  fresh,  but  on  exposure  become  coated  with  an  opaque  layer  of 
crystals,  which  may  be  white,  yellowish,  or  sometimes  red  from  the  forma- 
tion of  an  allotropic  variety  of  phosphorus.  Phosphorus  inflames  so 
easily  that  it  needs  to  be  kept  under  cold  water,  in  which  it  is  practically 
insoluble;  in  ether,  turpentine,  and  oils  it  is  soluble  to  a  great  extent;  in 
rectified  spirit  it  is  but  slightly  so  (1  part  in  320);  in  chloroform,  1  per 
cent.;  but  in  bisulphide  of  carbon  it  is  wholly  soluble.  ("Fenian  fire" 
is  the  term  given  to  a  very  inflammable  solution  in  this  liquid,  containing 
70  per  cent.)  Naunyn  states  that  phosphorus  is  very  slightly  soluble  in 
water  at  96°  to  104°  F.  ;  it  is  more  soluble  in  organic  fluids.  The  ele- 
ment is  soft  and  flexible  at  ordinary  temperatures,  melts  at  110°,  and 
takes  fire  at  a  little  over  that  point;  it  is  luminous  in  the  dark,  and,  when 
exposed  to  air,  gives  off  white  vapors  of  phosphorous  acid,  exhaling  an 
odor  sui  generis,  which  has  been  compared  to  that  of  garlic. 

On  exposure  to  sunlight  or  to  heat  in  closed  vessels,  it  is  converted 
into  red  or  "  amorphous  "  phosphorus  —  a  brittle  powder  which  is  not 
acted  on  by  the  air,  and  is  insoluble;  when  volatilized,  this  reverts  to  the 
ordinary  form. 

Amorphous  phosphorus  has  been,  by  some  observers,  credited  with 
physiological  activity.  Thus,  Bednar  used  it  for  a  long  period  in  small 
doses,  and  observed  symptoms  of  excitation,  trembling,  and  clonic  con- 
vulsions; but  as  much  as  1  oz.  has  been  given  to  dogs  without  percepti- 
ble effect.  Thompson,  in  twelve  carefully  observed  cases,  found  its  ac- 
tion nil,  and  plausibly  attributes  its  supposed  powers  to  a  slight  amount 
of  contained  ordinary  phosphorus  (Pharmaceutical  Journal,  July,  1875). 


36  MATERIA    MEDICA    AND    THERAPEUTICS. 

I  believe  it  to  be  practically  inert,  and  the  following1  observations  will 
refer  only  to  the  ordinary  form. 

Zinci  Phosphidum  —  Phosphide  of  Zinc,  PZns  (not  officinal).  A 
grayish,  friable  substance,  having  a  lustrous,  crystalline  fracture,  stable  at 
ordinary  temperatures,  readily  decomposed  by  weak  acids,  almost  taste- 
less, but  possessing  active  properties  like  those  of  phosphorus. 

ABSORPTION  AND  ELIMINATION. — Phosphorus  taken  by  the  mouth, 
and  especially  when  finely  divided  or  dissolved,  is  absorbed  into  the 
blood  under  the  influence  of  alkaline,  albuminoid,  or  oleaginous  materials 
with  which  it  meets  in  the  stomach  and  intestine;  the  amount  and  the 
rapidity  of  its  absorption  are  proportionate  to  the  amount  of  such  mate- 
rials, and  especially  of  fats,  which  are  its  best  solvents.  The  exact  con- 
dition in  which  it  circulates  is  still  a  subject  for  discussion ;  according  to 
varying  circumstances  some  portion  may  pass  into  the  blood  unaltered 
(Orfila,  etc.),  another  oxidized,  as  hypophosphorous,  phosphorous,  or  phos- 
phoric acid  (Frerichs,  Munk  and  Leyden,  etc.),  and  a  third  portion  as 
phosphuretted  hydrogen  (Lecorche  :  Archives  de  Physiologie,  1-2).  It 
has  been  found  in  each  of  these  forms  in  certain  cases  of  poisoning,  though 
in  other  cases  none  at  all  has  been  detected. 

Portions  of  unabsorbed  phosphorus  pass  sometimes  with  the  faeces, 
rendering  them  phosphorescent,  and  the  urine  has  presented  a  similar 
appearance:  the  element  has  also  been  found  in  a  free  state  in  the  liver, 
ten  hours  after  death  (Dybkowsky);  it  is  eliminated  by  it,  and  by  the 
other  glandular  organs,  by  the  skin,  and  by  the  lungs. 

PHYSIOLOGICAL  ACTION  (EXTERNAL). — When  applied  in  substance, 
phosphorus  vhas  been  known  to  inflame  on  the  skin,  and,  indeed,  has 
been  used  as  a  rnoxa;  it  is  liable  to  cause  very  troublesome  sores  and 
even  gangrene,  and  the  same  results  may  follow  its  use  in  ointment.  In 
certain  experiments  on  dogs,  however,  when  pieces  of  the  element  were 
placed  in  the  cellular  tissue  they  remained  unaltered  as  to  size  and  trans- 
lucency,  and  no  inflammation  was  excited,  yet  the  animals  are  said  to 
have  died  in  a  few  weeks  from  phosphorus-poisoning;  while,  on  the 
other  hand,  rabbits  and  some  other  animals  treated  in  the  same  way  did 
not  show  either  local  or  general  symptoms.  Trasbot  records  a  curious 
circumstance  :  a  dog  swallowed  a  stick  of  phosphorus,  and  no  symptoms 
of  local  irritation  appeared,  and  afterward  it  was  found  in  an  abscess  as 
an  ordinary  foreign  body  might  have  been.  It  is  not  easy  to  draw  definite 
conclusions  from  such  experiments,  other  than  that  pure  phosphorus  does 
not  necessarily  act  as  a  local  irritant  (Ranvier:  Gazette  Medicale,  1867; 
Archives  Generates,  1868).  Phosphorus  vapor  causes  irritation,  catarrh, 
and  even  inflammation  of  mucous  membranes  with  which  it  comes  in  con- 
tact, especially  the  conjunctival  and  respiratory  membranes;  it  has  also 
a  special  effect  in  causing  inflammation  of  the  periosteum  and  bone,  with 
necrosis  of  exposed  parts,  such  as  the  maxilla  and  teeth.  It  is  only  when 


PHOSPHORUS.  37 

* 

the  phosphorus  vapor  directly  reaches  the  periosteum  or  some  raw  vascu- 
lar surface  in  immediate  connection  with  the  nutrition  of  bone,  and  when 
its  application  is  prolonged  under  particular  circumstances  of  tempera- 
ture, and  probably  of  oxidation,  that  its  injurious  effects  are  witnessed. 
Thus  it  is,  when  there  are  carious  teeth  in  the  jaw,  and  the  fumes  can 
act  directly  on  the  exposed  dental  pulp,  that  necrosis  occurs,  and  it  is 
noteworthy  that  not  until  eleven  years  after  the  opening  of  the  match 
factory  in  Vienna  was  the  first  case  of  this  kind  seen,  and  only  those  en- 
gaged in  "  dipping  and  drying  "  the  matches  were  affected.  The  disease 
is  more  common  in  the  lower  jaw,  but  not  rare  in  the  upper,  and  it  has 
also  attacked  the  palate  and  frontal  bones.  The  general  health  of  the 
workers  previous  to  the  necrosis  or  buccal  inflammation  is,  with  the  ex- 
ception of  pulmonary  catarrh,  remarkably  good. 

PHYSIOLOGICAL  ACTION  (INTEKTSTAL). — D-igestive  System. — After  tak- 
ing, in  ethereal  tincture,  -£$  gr.  each  morning  for  ten  days,  and  then  T^g- 
gr.  for  nearly  four  weeks,  I  experienced  increased  thirst  and  dryness  of 
mouth,  with  coated  tongue,  flatulent  distention  and  eructation,  and  un- 
easy feeling  in  the  region  of  the  gall-bladder,  without  nausea  or  vomit- 
ing; the  motions  were  dark,  but  healthy,  the  urine  natural.  There  was 
slight  headache  and  sense  of  fulness  along  the  vertex  and  over  the  left 
temple,  with  increased  restlessness  and  sleeplessness.  On  discontinuing 
the  medicine,  these  symptoms  disappeared  in  about  three  days,  and  on 
resuming  it  at  the  end  of  a  month  I  felt  them  return  in  about  ten  days' 
time.  Other  persons  may  take  the  quantity  just  mentioned  without  so 
much  inconvenience,  but  larger  doses  (^  to  -fa  gr.  and  upwards)  are 
very  liable  to  disorder  the  stomach,  causing  nausea  and  a  sense  of 
warmth  or  irritation.  The  appetite  may  be  at  first  increased,  but  in 
many  patients  dyspepsia  quickly  occurs,  and  nausea,  flatulence,  colic,  or 
diarrhoea  hinders  the  employment  of  at  least  the  ordinary  preparations  of 
phosphorus.  A  silvery  white  condition  of  the  tongue  may  be  caused, 
and  the  gums  may  become  inflamed.  Zinc  phosphide  in  any  quantity 
above  •£  gr.  readily  induces  vomiting. 

Professor  Gubler,  examining  the  effects  of  this  phosphide  upon  arti- 
ficial digestion,  found  that  the  phosphuretted  hydrogen  which  was  de- 
veloped arrested  the  process,  and  he  concluded  that  the  same  thing  oc- 
curred with  other  preparations  of  phosphorus  taken  by  the  stomach;, 
while  Dr.  A.  Thompson  attributes  gastric  irritation  to  the  formation  of 
hypophosphorous  acid,  and  states  that  he  has  only  seen  these  symptoms 
occur  after  the  use  of  mixtures  prepared  with  a  vegetable  oil. 

Whatever  the  precise  explanation  may  be,  the  limit  of  medicinal  and 
the  commencement  of  toxic  doses  is  marked  by  more  evident  irritation  of 
the  digestive  organs — the  mouth  becomes  tender  and  sore,  the  nausea  is 
accompanied  with  retching,  vomiting,  and  diarrhoea;  tenderness  and  en- 
largement of  the  liver  may  be  detected,  and  there  is  an  icteric  tint  of 


38  MATERIA    MEDICA    AND    THERAPEUTICS. 

skin  and  conjunctivas.  In  the  irritant  form  of  phosphorus-poisoning  (to 
be  described  separately),  these  symptoms  become  very  severe. 

Cutaneous  System — Mucous  Membrane. — A  good  deal  of  irritation 
with  hyperaesthesia  may  be  determined  in  the  skin  and  the  conjunctivas, 
as  well  as  in  the  buccal  membrane,  by  the  use  of  phosphorus.  It  is  not 
easy  to  say  whether  this  is  caused  by  the  elimination  of  the  drug,  or  by 
the  presence  of  biliary  compounds  from  altered  liver-function,  or  from 
impaired  blood-condition;  the  icteric  tint  has  been  already  mentioned. 
In  cases  of  poisoning,  erythematous  and  hemorrhagic  patches  occur  in 
the  skin,  and  increased  perspiration  has  been  traced  to  the  medicinal  use 
of  the  drug. 

Genito-urinary  System. — There  is  but  little  evidence  of  any  stimulus 
to  the  generative  function  or  organs  exerted  by  phosphorus  given  to 
healthy  subjects,  whatever  may  be  its  power  in  certain  forms  of  disease. 
The  stimulation  that  has  been  noted  in  some  cases,  both  of  men  and  ani- 
mals, was  not  special,  but  merely  a  part  of  the  general  stimulus  to  the 
whole  nervous  system.  Leroy,  indeed,  and  some  other  French  authors, 
have  reported  some  temporary  genital  stimulation  from  large  doses,  and, 
in  a  few  cases  of  poisoning,  irritation  and  excitement  of  the  genitalia 
have  been  recorded,  but  they  are  to  be  explained  as  above.  Thompson 
gave  to  two  healthy  adults  1  to  1£  gr.  of  zinc  phosphide  daily  for  eight  or 
nine  days,  and  to  another  £  to  -J-  gr.  of  free  phosphorus  until  symptoms 
of  incipient  poisoning  arose,  but  without  any  trace  of  aphrodisiac  effect. 
Dr.  Eames  has  reported  similar  negative  results  from  observations  with 
phosphuretted  oil,  and  Mr.  Bradley's  experience  is  to  the  same  effect. 

With  special  reference  to  this  point,  I  have  myself  carefully  experi- 
mented upon  twenty  healthy  men.  Ten  of  them  took  ^V  g'r-  daily  for  a 
fortnight;  five  took  -J  gr.  each  day  for  a  similar  period;  and  the  other 
five  took  £  gr.  every  third  day  for  five  successive  doses.  Toxic  symp- 
toms occurred  in  some  of  the  subjects,  but,  except  possibly  in  one  of  the 
last  set,  no  sign  or  feeling  of  increased  sexual  excitement  was  observed. 
I  have,  however,  seen  men  from  forty  to  sixty  years  of  age,  apparently 
in  good  health,  but  suffering  from  complete  loss  of  generative  power  (in 
consequence  either  of  previous  sexual  abuse,  or  of  overtaxed  brain  and 
nervous  system),  in  whom  very  small  doses — -jj-g  gr.  thrice  daily — caused 
weak  erections  and  involuntary  emissions,  but  mental  depression  was  de- 
veloped to  such  an  extent  as  to  compel  the  suspension  of  the  drug:  this 
implies  a  state  of  irritation,  but  certainly  not  one  of  increased  tone  or 
strength. 

With  regard  to  its  influence  upon  the  uterus,  we  have  evidence  that 
long-suppressed  menstruation  may  reappear  under  its  continued  use  in 
small  doses,  but  this  may  reasonably  be  connected  with  improvement  in 
the  blood-condition  rather  than  with  specific  stimulation;  in  cases  of  poi- 
soning, however,  uterine  hemorrhage  and  abortion  occur  (v.  p.  41). 


PHOSPHORUS.  39 

The  urine  under  the  influence  of  phosphorus  becomes  high-colored 
and  loaded,  sometimes  phosphorescent,  and  with  a  smell  of  violets,  or  of 
sulphur. 

Husemann  reports  the  nitrogenous  constituents  increased  in  amount, 
and  more  recently,  in  dogs  poisoned  by  phosphorus,  Bauer  found  the 
excretion  of  urea  notably  increased — 20  to  90  per  cent,  above  normal 
(Zeitschrift  far  Biologie,  Bd.  xiv.,  Hft.  4,  1878);  the  phosphates  are  un- 
altered in  quantity  (Derlon).  Leucin,  tyrosin,  and  paralactic  acid  have 
been  found  in  cases  of  poisoning. 

Osseous  System. — Wegner  has  furnished  definite  proof  that  phospho- 
rus stimulates  the  growth  of  true  bone,  for,  after  giving  minute  doses 
continuously  to  animals,  he  found  the  epiphyseal  cartilages  ossify  more 
quickly  and  more  completely  than  usual,  and  the  cancellous  and  compact 
bone  become  more  dense,  even  to  the  extent  of  obliterating  the  medul- 
lary canal  (Virchow's  Archiv,  June  22,  1872).  Exostoses  commonly  form 
in  cattle  feeding  near  the  bone-works  at  Swansea,  and  have  been  plausi- 
bly traced  to  phosphorus  fumes  in  the  surrounding  atmosphere  (Stanley 
on  Bones:  JHedical  Times,  1854),  and  although  we  find  clinically  that  in- 
flammation and  necrosis  follow  the  direct  local  irritation  of  strong  phos- 
phorus vapor,  yet  even  in  such  cases  exostoses  commonly  form  in  another 
part  of  the  same  bone. 

Nervous  System. — The  fact  just  recorded  of  phosphorus  stimulating 
the  growth  of  bone — a  tissue  of  which  it  forms  a  component  part — has 
led  to  the  inference  that  it  can  stimulate  the  nutrition  of  nerve-tissue,  of 
which  also  it  forms  a  normal  constituent;  but  the  evidence  on  this  sub- 
ject is  rather  clinical  than  experimental.  Gubler  describes  the  effect  of 
"sV  *°  iV  £r'  *°  ke  a  "  general  sense  of  stimulation  more  complete  than 
that  caused  by  coffee,  more  active  than  that  produced  by  opium."  A. 
Thompson  speaks  of  it  as  producing  "  exhilaration  and  increased  capacity 
for  exertion,  both  mental  and  physical,  and  an  effect  like  that  of  alcohol 
without  the  subsequent  depression."  He  states  also  that  if  ^  to  1  gr.  be 
taken  in  the  course  of  twenty-four  hours,  the  feelings  described  are  more 
sustained,  and  transient  giddiness  or  quasi-intoxication  occurs.  There 
seems  to  me  some  exaggeration  in  these  accounts,  but  it  is  within  my 
own  experience  that  a  general  tonic  effect  may  be  obtained  from  these 
and  smaller  quantities  of  the  drug.  In  cases  where  poisonous  symptoms 
are  developed,  marked  excitement,  tremor,  and  spasmodic  muscular 
twitching  occur,  and,  in  severe  cases,  cramp  or  partial  paralysis,  delirium, 
convulsion,  collapse,  or  coma. 

Circulatory  System. — In  accordance  with  the  slight  general  excita- 
tion already  described,  the  pulse  and  temperature  are  slightly  raised 
about  an  hour  after  taking  doses  of  ^ff  gr. ;  and  after  such  doses,  given 
daily  for  some  weeks,  the  circulation  has  been  found  more  equable  and 
more  steady  than  before  (Dr.  Ford  on  fifteen  patients:  American  Journal 


40  MATERIA    MEDICA    AND    THERAPEUTICS. 

of  Insanity,  January,  1874).  Thompson  has  noted  dilatation  of  the  skin- 
capillaries.  In  toxic  cases  the  pulse  rises  to  120  or  more  per  minute,  and 
the  temperature  to  102°  to  103°  F.,  though  this  condition  is  only  tem- 
porary. 

Dr.  Gowers  has  proved  that,  under  the  influence  of  small,  continued 
doses,  the  proportion  of  red  blood-corpuscles  is  increased  (British  Medi- 
cal Journal,  i.,  1878),  at  least  in  lymphoma,  and  this  interesting  observa- 
tion may  throw  light  on  the  tonic  power  of  the  drug. 

Toxic  ACTION. — The  poisonous  symptoms  produced  are  essentially  of 
irritant  and  destructive  character,  but  vary  in  degree,  and  are  often 
obscure  and  insidious — probably  in  proportion  to  the  varying  amount 
absorbed,  or  the  chemical  changes  the  drug  undergoes  under  different 
circumstances.  Lecorche  makes  three  forms  of  "  acute  phosphorismus  ": 
1,  that  produced  by  phosphuretted  hydrogen;  2, that  by  phosphoric  acid; 
3,  a  mixed  form;  but  the  clinical  varieties  described  by  Trousseau,  or 
better  by  Dr.  Guy,  are  of  more  practical  importance — he  names  them  as 
1,  the  irritant;  2,  the  nervous;  and  3,  the  hemorrhagic  form — and  a  brief 
notice  of  them  comes  within  the  scope  of  our  subject,  because  it  will  help 
to  fix  in  the  mind  of  the  reader  the  characters  of  the  full  physiological 
action  of  the  drug. 

1.  The  irritant  form  is  the  most  common:  it  is  induced  (on  the  Con- 
tinent, not  infrequently)  by  swallowing  match-heads,   or  a    certain  rat- 
poison  paste.      A  foul  taste  and  smell,  like  garlic  or  sulphur,  are  first 
perceived,  then  heat  and  swelling  of  the  tongue  and  fauces,  pain  and  dis- 
tension of  the  stomach,  bilious  and  mucous  vomiting  and  purging,  with 
colic  and  abdominal  tenderness.     The  ejecta  occasionally  contain  blood, 
and  may  be  phosphorescent,  and  the  faeces  contain  small  masses  of  crys- 
tals of  the  fatty  acids,  and  later  in  the  attack  become  clay-colored.     The 
pulse  rises  to  120  or  higher,  and  the  temperature  to  102°  or  103°  F. ;   but 
this  pyrexia  passes  away  as  the  gastro-intestinal  symptoms  become  very 
severe,  and  is  succeeded  by  an  opposite  condition  (Gubler). 

In  the  early  stages  there  is  pronounced  nerve-excitement,  with  hyper- 
sesthesia,  agitation,  talkative  delirium,  and  delusion,  which  is  sometimes 
of  erotic  character,  though  priapism  is  rare.  Muscular  twitchings  and 
cramps,  and  even  general  convulsions  occur,  but  later  on  follow  prostra- 
tion, fainting,  and  collapse,  loss  of  muscular  sense,  and  of  sensation,  re- 
tention of  urine,  and  partial  paralysis,  affecting  mostly  the  extensor  mus- 
cles. 

2.  In  the  nervous  form  these  latter  symptoms  become  much  more 
marked,  but  there  is  little  pyrexia;  erythematous  spots  occur  in  the  skin, 
which  is  dry  and  yellow,  and  later  becomes  cold;  dilatation  of  pupil  and 
strabismus  are  described,  and  the  fatal  termination  comes  on  with  som- 
nolence and  coma. 

3.  The  hemorrhagic  form  is  less  quickly  fatal  than  the  others.     In  it 


PHOSPHORUS.  41 

the  ejecta  are  almost  wholly  sanguineous;  bleeding  occurs  in  and  from 
the  skin  and  mucous  membranes,  and  many  parts  of  the  body.  It  is  due 
partly  to  the  altered  blood-state,  and  partly  to  general  softening  of  the 
tissues,  including  fatty  degeneration  of  vessels  (Lebert).  In  women 
there  is  uterine  hemorrhage,  miscarriage,  or  abortion — but  these  may  be 
due  to  the  irritant  effects  on  the  intestinal  canal. 

In  all  cases  of  phosphorus-poisoning,  about  the  third  or  fourth  day 
pain  is  felt  over  the  liver,  and  is  followed  shortly  afterward  by  jaundice, 
headache,  and  sleeplessness;  the  urine  is  found  to  contain  bile,  and  gen- 
erally albumen,  leucin,  tyrosin,  and  paralactic  acid.  The  presence  of 
bile  is  an  argument  that  the  jaundice  depends  not  on  suppression,  but  on 
occlusion  of  the  biliary  passages,  which  is  probably  catarrhal  in  character. 
In  exceptional  cases  (in  which,  probably,  only  a  small  amount  of  the 
poison  has  been  absorbed)  there  has  been  neither  gastro-enteritis,  nerve- 
excitement,  nor  quick  pulse,  but  the  prominent  symptoms  have  been 
jaundice  and  hepatic  congestion  (British  and  Foreign  Review,  April, 
1863).  The  time  that  elapses  from  the  taking  of  the  phosphorus  to  the 
appearance  of  symptoms  varies  from  a  few  minutes  to  two  days.  Death, 
when  it  occurs,  is  usually  from  asthenia,  but  the  course  of  the  illness  is 
not  always  steadily  progressive:  sometimes  the  severe  symptoms  subside 
for  a  few  hours  or  days,  and  death  takes  place  suddenly,  from  failure  of 
the  cardiac  muscle  (Habershon:  Medico-  Chinirgical  Transactions,  v., 
50).  A  fatal  dose  may  be  stated  as  about  1  to  2  gr.  for  adults,  but  much 
less  for  children,  in  whom  vomiting  and  convulsions  are  usually  the  prom- 
inent symptoms. 

TOLERANCE. — The  system  may  become  habituated  to  the  use  of  phos- 
phorus to  some  extent,  and  a  gradual  increase  of  dose  may  be  borne  up 
to  an  amount  which  would  not  at  first  be  tolerated.  In  using  it  for 
neuralgia,  Thompson  has  found  that  cases  not  relieved  by  a  gradually  in- 
creased dose  have  yielded  to  a  similar  dose,  given  at  once  after  allowing 
an  interval  to  elapse.  Any  "  cumulative  action,"  so  called,  may  be  ex- 
plained by  the  mechanical  accumulation  of  the  drug  in  the  stomach  or 
intestines. 

PATHOLOGICAL  CHANGES  INDUCED  BY  PHOSPHORUS. — Ecchymoses  and 
gangrenous  spots  have  been  found  in  the  intestinal  tract,  together  with 
swelling  and  softening  of  the  mucous  membrane  and  mesenteric  glands; 
rarely  perforation.  The  viscera  are  hypersemic,  and  oedema  and  hemor- 
rhagic  infiltration  affect  the  skin,  serous  membranes,  and  other  tissues, 
especially  the  mediastinum;  hemorrhage  has  also  occurred  between  the 
spinal  membranes,  thus  accounting  for  a  paralysis.  The  blood  itself  is 
black  and  viscid,  and  in  many  cases,  even  during  life,  the  corpuscles  are 
destroyed  and  the  haemoglobin  altered,  so  that  it  will  not  show  the  usual 
spectrum  (Lecorche,  Voit,  etc.) ;  in  others  the  corpuscles  have  been  found 
normal  after  death,  and  the  blood-crystals  (of  haemoglobin  and  haemato- 


42  MATEKIA   MEDIC  A    AND    THERAPEUTICS. 

crystalline)  found  unchanged  (Lebert,  Gubler);  but  in  all  cases  the  blood 
and  the  solid  organs  contain  an  increased  proportion  of  waste  products, 
such  as  urea,  creatin,  leucin,  tyrosin,  etc.,  and  fatty  degeneration  affects 
every  tissue.  The  muscles,  including  the  cardiac  muscle,  are  discolored, 
soft,  and  fatty,  the  capillary  walls  are  degenerated  in  a  similar  manner, 
the  gastric  glands  and  renal  tubules  are  choked  with  fatty  epithelium,  and 
the  liver  especially  is  enlarged,  yellow  in  color,  and  its  cells  filled  with 
fat-globules;  in  protracted  cases,  cell-atrophy  occurs. 

The  condition  described  resembles  closely  that  found  in  an  idiopathic 
malady,  "acute  yellow  atrophy"  of  the  liver,  and  the  question  of  diag- 
nosis has  been  raised  in  medico-legal  cases  (Annales  cTIIygi&ne,  Januarv, 
1869).  An  illustration  is  recorded  by  Surgeon-Major  Martin,  in  a  man  ad- 
mitted to  Netley  Hospital  without  any  history  of  poison,  and  whose  case 
was  diagnosed  as  acute  yellow  atrophy;  it  was  only  after  death  that  the 
real  fact  of  phosphorus-poisoning  was  disclosed  by  examination  (British 
Medical  Journal,  i.,  1878). 

THEORY  OF  ACTION. — The  direct  irritant  effects  on  the  intestinal 
canal  depend  rather  upon  the  oxygen — or  hydrogen — compounds  formed, 
than  upon  phosphorus  itself,  and  the  pain,  vomiting,  prostration,  etc.,  fol- 
low from  the  local  irritation  produced,  just  as  with  other  corrosive  poisons. 

To  explain  the  other  constitutional  symptoms,  and  the  subsequent 
arrest  of  nutrition  and  fatty  degeneration,  several  modern  writers  have 
argued  that  the  strong  affinity  of  phosphorus  for  oxygen  leads  it  to  ab- 
stract that  vital  gas  from  the  blood,  and  so  induce  a  condition  of  asphyxia 
(Eulenburg  Lecorche);  but,  as  oxygen  would  be  continually  renewed  by 
inspiration,  and  the  amount  that  can  be  absorbed  by  the  metalloid  is  only 
limited,  I  cannot  see  that  such  serious  consequences  would  result;  neither 
would  asphyxia  produce  preliminary  excitement  nor  subsequent  waste, 
nor  is  the  blood  of  poisoned  animals  always  found  black;  it  is  sometimes 
red,  a  condition  incompatible  with  asphyxia  (Vigier:  Bulletin,  1868). 
Others  have  argued  that  phosphorus  indeed  removes  oxygen  from  the 
blood  and  the  tissues,  but  with  the  main  result  of  forming  phosphorous 
and  phosphoric  acids,  which  act  as  local  corrosive  agents,  and  which,  after 
absorption,  destroy  blood-corpuscles.  The  stomach  contains  some  free 
oxygen,  especially  after  food  (Chevreul),  and  it  has  been  suggested  that, 
when  the  drug  is  taken  under  circumstances  which  favor  its  retention  in 
the  stomach  and  its  oxidation  there,  then  gastro-intestinal  troubles  are 
the  most  marked  (irritant  form  of  poisoning).  That  phosphoric  acid  is 
formed  in  the  system  seems  proved  by  its  excretion  from  the  lungs;  and 
further,  it  is  pointed  out  that  this  acid,  when  injected  into  the  veins,  will 
destroy  the  corpuscles,  and  will  lead  to  fattj'  degeneration  (Personne); 
and  although  it  will  not  act  thus  when  given  by  the  mouth,  yet  it  may 
do  so  when  directly  generated  within  the  system  by  the  oxidation  of  free 
phosphorus.  While  allowing  this  to  some  extent,  I  cannot  believe  it 


PHOSPHORUS.  43 

possible  that  a  sufficient  amount  to  account  for  such  results  could  be 
formed  in  this  manner.  Again,  oxygen  has  proved  an  antidote  to  phos- 
phorus-poisoning (Crocq),  and  turpentine  acts  as  an  antidote  by  a  process 
of  oxidation,  while  free  ventilation  is  the  best  means  of  preventing  necrosis 
of  the  maxilla,  etc.,  in  phosphorus  factories  (Savory,  Sieveking),  so  that 
it  seems  at  least  unlikely  that  oxidation  of  phosphorus  is  the  cause  of  its 
ill-effects. 

In  explaining  the  action  of  the  drug  I  incline  to  accept  the  theory  of 
Gubler,  who  suggests  that  it  acts  chiefly  by  the  strong  ozonizing  power 
which  we  know  burning  phosphorus  to  possess.  Although  through  this 
combustion  a  minimum  quantity  of  oxygen  gets  lost  for  the  respiration, 
the  remainder  would  shortly  acquire,  from  its  admixture  with  the  ozonized 
portion,  so  great  an  increase  in  combustion  power  as  to  be  very  likely  to 
induce  general  stimulation  of  the  system.  But  increased  activity  is  ac- 
companied by  an  increased  waste,  particularly  of  the  blood-cells;  anaemia 
follows  this  irregular  activity,  and  fatty  degeneration  of  the  tissues  and 
impairment  in  the  function  of  the  different  organs  take  place.  On  the 
other  hand,  amorphous  phosphorus,  which  has  no  ozonizing  power,  would 
fail  to  produce  any  such  symptoms,  as  is  really  the  case;  but  more  accu- 
rate analyses  of  the  secretions  are  required  in  order  to  support  this  hypo- 
thesis. The  excretion  of  carbonic  acid  is  said  to  be  lessened  (Rabuteau) 
— we  should  not  expect  this  unless  in  advanced  stages;  as  already  stated, 
nitrogenous  excretions  are  increased  in  amount,  while  the  urinary  phos- 
phates remain  about  normal. 

I  have  still  to  refer  to  the  effects  of  Phosphuretted  Hydrogen,  which 
would  readily  be  formed  from  water  and  phosphorus,  or  from  any  phos- 
phides, or  from  the  very  unstable  hypophosphorous  acid.  We  have  seen 
that  this  gas  interferes  with  the  digestive  process,  and  we  know  that,  if  it 
be  passed  into  defibrinated  blood,  it  turns  it  black  and  destroys  its  haemo- 
globin (Dybkowsky) ;  also  that  it  possesses,  equally  with  phosphoric  acid, 
and  other  acids  and  substances  which  act  destructively  on  the  blood,  the 
power  of  inducing  fatty  degeneration  from  impaired  nutrition  (Bence 
Jones  and  others:  Medical  Times,  ii.,  18G5,  p.  593).  The  formation  of 
phosphuretted  hydrogen  in  the  system  would  equally  well  explain  the 
production  of  the  principal  toxic  effects  of  free  phosphorus,  and  I  incline 
to  attribute  them  largely  to  it.  Lecorche  states  that  this  compound  has 
been  found  in  the  tissues  in  fatal  cases,  and  he  connects  its  presence 
specially  with  the  second  or  neurotic  form  of  poisoning,  in  which  the 
course  is  rapid  and  nerve-symptoms  are  prominent. 

Fatty  degeneration  was  found  by  Munk  and  Leyden  in  the  tissues  of 
frogs  and  rabbits  within  two  or  three  days  after  giving  phosphorus 
(Medical  Times,  ii.,  1865,  p.  593),  and  since  these  researches  its  occur- 
rence in  phosphorus-poisoning  has  been  amply  demonstrated,  especially 
by  German  observers  (v.  Naunyn  in  Ziemssen's  "  Cyclopaedia  "). 


44  MATEBIA    MEDICA    AND    THERAPEUTICS. 

In  Tamassia's  experiments  it  was  very  rapidly  produced.  He  in- 
jected 3,  4,  5,  6  gr.  respectively  into  the  rectum  of  four  animals  (dogs 
and  rabbits);  toxic  symptoms  occurred  in  about  fifteen  minutes,  death  in 
eight  hours  (the  temperature  falling  8°  F.).  In  all  four  of  the  animals 
the  kidneys,  and  in  two  of  them  the  liver  also,  were  in  a  state  of  fatty 
degeneration  ( Medical  Record,  January,  1878). 

SYNERGISTS. — Arsenic  is  allied  to  phosphorus  in  its  power  of  acting 
upon  the  blood  (with  advantage  in  small  doses,  in  large  doses  with  de- 
structive effect),  also  in  its  action  upon  nutrition.  Cantharides,  oxygen, 
and  stimulants  have  somewhat  analogous  stimulating  powers.  It  is  a 
curious  speculation  that  ergot  of  rye  owes  its  properties  to  the  phosphoric 
acid  it  contains  (Levi:  British  and  Foreign  Review,  April,  1876). 

Adjuvants  are  found  in  phosphoric  acid,  and  in  fatty  and  fleshy  foods. 
Phosphoric  acid  has  especially  been  shown  to  develop  or  augment  the 
powers  of  phosphorus,  probably  from  aiding  in  its  solution  and  circulation 
(Personne).  The  brains  of  animals  and  the  flesh  of  hogs  are  said  to  be 
rich  in  phosphorus,  and  roast  food  to  retain  more  than  boiled. 

ANTAGONISTS — ANTIDOTES. — Hydrate  of  magnesia,  or  of  lime,  will 
neutralize  the  acid  compounds  of  phosphorus,  and  carbon  will  absorb 
phosphorus  vapor.  Sulphide  of  carbon  antagonizes  the  excitant  action 
of  the  drug,  as  also  do  sulphuretted  hydrogen,  aneesthetics  generally,  and 
cyanides  (Gubler).  Nitrate  of  silver  was  recommended  as  antidotal  by 
Bellini  (Medico-  Chirurgical  Review,  ii.,  1875). 

In  an  important  experiment  by  Crocq,  oxygen  was  used  as  an  anti- 
dote, defibrinated  blood  charged  with  the  gas  being  injected  into  the 
veins,  with  the  effect  of  restoring  to  its  normal  condition  the  dark,  pitch- 
like  blood  of  poisoned  animals  (British  and  Foreign  Review,  ii., 
1875). 

But  the  two  antidotes  which  claim  special  attention  are  sulphate  of 
copper  and  oil  of  turpentine.  With  any  soluble  salt  of  copper,  phos- 
phorus forms  a  black  phosphide,  non-poisonous;  and  as  copper  sulphate 
is  also  a  good  emetic,  it  is  specially  available  for  cases  when  the  poison 
has  been  taken  by  the  stomach,  and  when  the  remedy  can  be  given  soon 
afterward.  Five  grains  should  be  given  every  two  or  three  minutes  until 
free  vomiting  is  induced,  and  then,  either  continued  in  smaller  doses  and 
with  opium,  or  turpentine  may  be  substituted. 

If  oil  of  turpentine  be  brought  into  contact  with  phosphorus  at  a  suit- 
able temperature,  a  crystalline  white  solid  is  formed — terebinthino-phos- 
phorous  acid — which  is  not  poisonous.  Kohler  and  Schimpf  obtained  it  by 
adding  gradually  2  Ibs.  of  the  oil  to  f  oz.  of  the  element  at  40°  C.,  and 
the  same  substance  has  been  obtained  in  the  distillate  from  urine  in  cases 
of  poisoning  (Pharmaceutical  Journal,  March,  1873).  To  produce  the 
desired  result,  the  oil  must  come  into  direct  contact  with  phosphorus  in 
the  stomach,  and  in  the  proportion  of  about  100  parts  to  each  one  of  the 


PHOSPHORUS.  45 

latter.  Eleven  hours  is  the  longest  time  that  has  elapsed  before  the  ad- 
ministration of  the  remedy  in  successful  cases.  Moreover,  it  is  not  every 
kind  that  will  act  well;  the  pure  rectified  oil,  and  much  of  that  imported 
as  German  and  American,  do  not  form  the  crystalline  acid,  and  hence  a 
difference  in  the  results  of  some  observers.  It  is  the  crude,  acid,  French 
oil,  or  that  which  has  been  ozonized  by  long  exposure,  which  gives  reliable 
results.  It  is  said  also  that  milk  lessens  its  good  effect. 

A  case  illustrating  the  value  of  both  the  antidotes  recommended  oc- 
curred in  my  practice  some  years  ago.  A  young  man  (insane  from  over- 
study  for  examination)  swallowed  some  pieces  of  solid  phosphorus,  and, 
while  his  friends  were  gone  for  assistance,  gashed  his  throat  and  body 
with  a  razor.  When  I  saw  him  the  most  pressing  need  was  to  stay 
hemorrhage,  and  while  doing  this  I  sent  for  some  copper  sulphate  and 
turpentine,  giving  him  at  once  mustard  and  water.  This  and  the  copper 
produced  good  emesis,  with  rejection  of  a  piece  of  phosphorus  two  inches 
long.  I  then  began  giving  turpentine  in  milk  (also  in  water),  but  still 
encouraged  vomiting,  because  from  the  small  pieces  left  in  the  patient's 
bottle  of  phosphorus  more  was  thought  to  have  been  taken.  Eventually 
two  other  pieces,  1£  in.  and  £  in.  long,  were  rejected,  after  having  been 
in  the  stomach  at  least  three  hours.  Several  more  doses  of  turpentine 
were  given,  and  the  patient  made  a  good  recovery,  with  the  exception  of 
some  dyspepsia:  he  was  seen  afterward  by  Dr.  Fuller,  the  family  physi- 
cian, and  passed  from  under  my  care,  but  is,  I  believe,  still  living  in  an 
asylum.  The  case  may  be  considered  another  illustration  of  the  fact  that 
large  pieces  of  phosphorus  are  less  dangerous  than  the  finely  divided  sub- 
stance; but  I  think  real  benefit  resulted  from  the  antidotes  used. 

A  case  is  reported  of  a  man  who  swallowed  120  match-heads,  and  then 
took  turpentine  to  increase  the  effect.  He  did  not  vomit,  but  recovered 
(Medico-  Chirurgical  JReview,  ii.,  1869,  p.  555). 

Other  cases,  cured  by  the  same  antidotes,  are  given  in  Braithwaite,  i., 
1872,  p.  131,  and  in  Sydenham  Society's  "  Year  Books,"  and  British 
Medical  Journal,  i.,  1878. 

THERAPEUTICAL  ACTION  (INTERNAL). — From  what  has  preceded,  it 
will  be  recognized  that  the  value  of  phosphorus  lies  in  its  power  of 
strengthening  and  giving  tone  to  the  nervous  centres  when  their  activity 
is  impaired;  also,  since  nerve-debility  is  a  cause  of  many  other  besides 
what  are  called  nervous  diseases,  a  nerve-tonic  of  this  kind  has  a  wide 
field  of  usefulness,  and  is  applicable  not  only  in  nerve-exhaustion  and 
pain,  but  in  many  conditions  of  adynamia.  Rabuteau,  however,  states 
an  opposite  view  when  he  says:  "I  do  not  hesitate  to  assert  that  this 
poison  has  never  cured  anything  up  to  the  present  time,  and  I  would 
never  prescribe  it;  it  has  always  been  useless"  ("Elements,"  p.  211); 
while  Beaumetz,  A.  Thompson,  and  others  have  recorded  wonderful  re- 
sults from  it.  The  truth  probably  lies  between  the  two  extremes,  and 


46  MATEBIA   MEDICA   AND   THERAPEUTICS. 

we  must  not  forget  that  some  failures  may  be  accounted  for  by  inactive 
preparations  of  a  drug  always  difficult  to  dispense. 

Neuralgia. — Eighty  years  ago  von  Lobel,  a  physician,  related  his  cure 
from  an  inveterate  cranial  neuralgia  (which  was  accompanied  with  debil- 
ity and  failure  of  mental  and  sensory  power)  by  an  ethereal  solution  of 
the  drug.  He  took  £  gr.  every  two  hours,  and  (with  one  relapse)  was  re- 
stored to  health  in  a  short  time,  and  after  only  a  few  doses.  This  experi- 
ence was  corroborated  to  some  extent,  and  the  remedy  came  into  great 
repute,  but  was  soon  found  to  be  a  dangerous  one  and  difficult  to  man- 
age, and  it  gradually  fell  into  disuse,  no  doubt  owing  to  the  largeness  of 
the  doses.  A  few  years  ago  Mr.  M.  Bradley  published  a  case  of  neuralgia 
of  the  chest-walls,  rapidly  cured  by  "tincture  of  phosphorus,"  after  fail- 
ure of  all  recognized  remedies,  and  later  he  recorded  other  successful  re- 
sults {British  Medical  Journal,  October,  1872).  In  the  following  year 
Dr.  Slade  King  added  testimony  to  its  value  in  doses  of  ^  to  -fa  gr. 
(Medical  Times),  and  Dr.  Ashburton  Thompson  recorded  forty  consecutive 
cases  either  cured  or  relieved  (Practitioner,  1873);  Mr.  Sanger,  of  Alfris- 
ton,  referred  to  an  equal  number  (British  Medical  Journal),  and  Dr. 
Hammond  praised  it  in  America  (Practitioner,  i.,  1877). 

Drs.  Radcliffe  and  Broadbent  may  be  cited  also  among  those  who  early 
employed  it  with  good  results,  the  latter  especially  in  "anginoid  pain" — • 
a  cardiac  neuralgia  (Practitioner,  1875).  It  was  found  useful  in  cases 
connected  with  extreme  general  debility — whether  from  over-lactation, 
hemorrhage,  or  simple  asthenia — in  cases  due  to  pregnancy,  to  cold,  and 
to  local  irritation,  such  as  carious  teeth,  and  even  to  rectal  cancer  (Thomp- 
son). Anstie's  experience  was  not  so  favorable. 

I  have  myself  seen  much  benefit  from  it  in  many  of  the  above  cases, 
also  in  uterine  neuralgia  occurring  in  sensitive  patients,  and  induced 
either  by  protracted  lactation,  excessive  sexual  passion,  or  by  mental  or 
local  causes.  The  severe  pain  is  apt  to  com'e  on  just  before  or  during  the 
monthly  period,  and  then  -j-J-j  to  -^  gr.  should  be  given  three  or  four 
times  daily;  during  the  interval  the  smaller  dose  should  be  given,  and 
less  frequently. 

Intercostal  Neuralgia. — For  upwards  of  twenty  years  I  have  been  ac- 
customed to  use  phosphorus  in  this  affection,  and  can  speak  favorably  of 
its  power.  I  have  notes  of  fifty-six  cases  wherein  the  pain  quickly  sub- 
sided under  this  treatment,  and  did  not,  so  far  as  I  know,  subsequently 
return.  In  some  instances  phosphorus  succeeded  where  arsenic  had  quite 
failed.  The  dose  was  yj^j-  to  •£•$  gr.  three  times  daily. 

With  regard  to  the  dose  of  phosphorus  in  neuralgia  and  nerve-disor- 
ders generally,  I  may  say  that  in  my  experience  the  comparatively  large 
doses  recommended  by  Dr.  A.  Thompson  cannot  be  tolerated  for  any 
length  of  time  by  the  system.  They  may  seem  at  first  to  stimulate,  or 
rather  over-stimulate,  the  nerve-centres,  but  after  a  short  time  they  de- 


PHOSPHORUS.  47 

press  in  a  disastrous  manner;  while  the  small  doses  of  ?*-$  to  -fa  gr.,  con- 
tinued for  due  time,  nourish  and  strengthen  nerve-tissue,  without  any 
evidence  of  undue  excitement.  A  therapeutical,  and  not  a  physiological 
action,  is  to  be  always  desired. 

Herpes  Zoster. — In  this  affection,  which  is  distinctly  neurotic,  I  have 
found  good  from  phosphorus,  for  it  has  in  some  instances  quickly  relieved 
the  severe  pain. 

Facial  Spasm. — Twitching  of  the  facial  muscles,  especially  about  the 
orbit,  often  occurs  in  cases  of  neuralgia  and  of  impaired  nerve-power.  I 
have  known  it  markedly  improved  by  phosphorus. 

Nerve- Exhaustion. — Gubler  found  phosphide  of  zinc  remove  the  sen- 
sation of  fatigue  after  hard  work,  improve  appetite  and  digestion,  and 
conduce  to  sleep.  He  gave  a  £-gr.  dose  with  an  ordinary  digestive  pill 
at  dinner-time;  but  such  a  dose  is  too  large,  and  is  very  liable  to  nau- 
seate. When  the  nervous  system  is  jaded  and  below  par,  so  that  slight 
impressions  are  too  deeply  felt,  and  the  nerve-controlling  power  is  im- 
paired, phosphorus  has  been  found  to  supply  what  is  wanting  for  a  time; 
also,  it  has  been  said  to  improve  intellectual  tone  in  those  subjected  to 
either  monotonous  brain-work  or  to  an  unusual  mental  effort  (Thompson). 
Dr.  Broadbent  early  recorded  some  striking  cases  of  this  kind:  one  of 
"  nervous  break-down  "  in  a  city  merchant,  with  insomnia,  and  extreme 
depression  and  incapacity  for  work,  and  another  in  which  "  epileptiform 
vertigo "  was  present  in  addition.  Both  got  well  "  quickly  and  com- 
pletely" under  phosphorus  (Practitioner,  1873). 

In  cases  of  Chronic  Exhaustion  of  Brain-Power,  or  of  general  nerve- 
exhaustion  consequent  on  chronic  disease,  small  doses  continued  for  a 
long  time  are  advisable,  and  have  been  plausibly  held  to  supply  to  the 
nerve-tissue  a  vital  element  in  which  it  is  deficient,  and  to  improve  its 
nutrition,  just  as  Wegner  showed  that  the  drug  improved  the  nutrition 
of  bone;  and  certainly  its  supply,  in  some  form,  to  nerve-tissue,  is  as  neces- 
sary as  that  of  iron  to  blood-corpuscles. 

I  have  reason  to  believe  that  benefit  may  be  obtained  from  phosphorus 
even  when  there  exists  evidence  of  atrophic  change  in  the  brain,  of  the 
nature  of  white  softening  or  chronic  fatty  degeneration,  with  such  symp- 
toms as  failure  of  memory  and  of  self-control,  loss  of  proper  sensation 
and  cerebral  power  generally.  These  are  commonly  associated  with  fee- 
ble heart-action,  and  with  arterial  degeneration,  and  may  occur  not  only 
in  advanced  life,  but  as  a  consequence  of  wasting  disease,  chronic  alco- 
holism, etc.  I  remember  well  a  case  of  this  kind  in  which  epistaxis  was 
a  frequent  symptom,  and  had  proved  rebellious  to  iron,  acids,  and  other 
ordinary  treatment  in  the  hands  of  experienced  men:  small  doses  of  phos- 
phorus (ethereal  tincture)  improved  the  patient  very  much  both  as  to  brain 
and  muscular  power,  but  the  symptoms  always  tended  to  recur  on  omis- 
sion of  the  remedy,  and  he  continued  it  for  a  long  time  with  good  results. 


48  MATEKIA    J1EDICA    AND    THERAPEUTICS. 

A  suitable  dose  is  -fa  gr.  thrice  daily  for  about  a  fortnight,  and  then  it 
should  be  reduced  to  -j-J-g.  gr.  or  less,  and  should  be  taken  for  twelve  to 
eighteen  months,  omission  being  made  for  about  ten  days  in  each  month. 

Although  I  do  not  find  this  experience  to  be  general,  yet  it  is  not 
•wholly  singular,  for  Dr.  Hammond  also  speaks  of  the  value  of  the  remedy 
in  conditions  of  softening;  he  recommends  similar  doses  given  with  cod- 
liver  oil,  or  zinc  phosphide  in  -fa  gr.  doses. 

Fatty  Degeneration. — That  a  different  action  may  be  obtained  from 
a  different  dose  of  the  same  medicine  is  an  elementary  therapeutical 
axiom  in  constant  application,  and  it  is,  I  believe,  a  clinical  fact  that 
phosphorus  can  relieve  the  symptoms  which  are  usually  associated  with 
fatty  degeneration,  not  only  of  the  brain,  but  of  other  organs.  I  have 
notes  of  more  than  thirty  cases  in  which  fatty  degeneration  of  the  heart 
might  fairly  be  diagnosed:  the  cardiac  sounds  were  feeble,  the  impulse 
weak,  the  pulse  slow,  sometimes  excited,  irregular,  soft,  and  compressi- 
ble; with  dyspnoea  on  exertion,  arid  a  sense  of  anxiety  and  tendency  to 
syncope  to  a  greater  or  less  degree;  arcus  senilis  sometimes  present. 
After  taking  phosphorus  for  a  few  months,  most  of  the  patients  were 
much  relieved,  and  were  able  to  move  about  without  fear,  and  with  com- 
parative comfort.  No  doubt  somewhat  similar  cardiac  symptoms  may  be 
caused  by  nerve-exhaustion  or  gout;  the  absolute  diagnosis  of  fatty  de- 
generation cannot  always  be  insisted  on,  and  I  do  not  wish  to  maintain 
that  phosphorus  reconstructs  degenerate  cells,  but  its  acknowledged 
power  over  nutrition  makes  it  reasonable  to  suppose  that  it  can  hinder 
or  stop  commencing  degeneration,  and  especially  improve  the  condition 
of  the  nervous  system. 

It  is  highly  important  to  carefully  proportion  the  dose  to  the  necessi- 
ties of  each  individual  case,  as  some  will  take  with  advantage  more  than 
others.  Where  the  heart-action  has  been  very  irregular,  or  the  dyspnoea 
and  syncopal  feelings  more  than  ordinarily  troublesome,  I  have  given  -fa  to 
•fa  gr.  occasionally;  but  these  doses  should  not  be  given  frequently,  for 
fear  of  aggravating  the  symptoms.  I  prefer  to  give  -gfa  to  y^^  or  fa  gr. 
twice  or  thrice  daily.  Not  only  in  heart  disease  of  the  kind  described, 
but  in  fatty  degeneration  of  other  organs,  and  in  the  form  which  threat- 
ens during  typhus  and  some  other  acute  diseases,  phosphorus  is  worthy 
of  attention. 

For  many  years  I  have  been  accustomed  to  use  it  in  such  cases,  and 
the  improvement  traceable  to  it  is  often  remarkable.  The  smaller  doses 
mentioned  are  to  be  preferred,  in  order  to  avoid  irritant  effects,  and  to 
get  the  system  slowly,  but  more  fully  under  the  influence  of  the  remedy; 
when  this  is  done,  the  effect  is  more  thorough  and  lasting. 

Exhaustion  of  Fevers,  etc. — The  value  of  phosphorus  in  conditions 
of  extreme  exhaustion  in  advanced  disease  is  one  of  the  earliest  recorded 
experiences  of  Kramer,  Mentz,  Leroy,  etc.  (1733-1798).  They  used  it 


PHOSPHORUS.  49 

in  the  muttering  delirium  and  incipient  coma  of  typhus,  the  collapse  of 
malignant  "bilious  fever,"  and  the  profound  depression  of  extensive  pneu- 
monia. Bayle  says,  "  in  every  disease  where  death  is  imminent  from 
failure  of  vital  force  without  much  structural  alteration,  phosphorus  is 
indicated.  We  see  this  in  severe  continuous  fevers  during  their  last 
stage,  whether  they  be  caused  by  some  miasm,  typhus,  plague,  etc.,  or 
by  '  spontaneous  alteration  of  the  blood,'  as  in  adynamia  or  putrid  fevers 
(so  called) ;  in  such  cases  phosphorus  reanimates  vitality,  furnishes  nature 
the  means  of  effectually  resisting  the  disease,  and  eliminating  its  material 
causes  by  natural  excretory  outlets.  It  is  indicated,  secondly,  in  all  acute 
exanthemata  when  eruption  has  disappeared  suddenly,  with  aggravation 
of  symptoms  (measles,  variola,  erysipelas,  low  fever  with  exanthem); 
thirdly,  in  malignant  pustule,  where  the  disease  has  reached  its  acme 
and  the  vital  power  is  almost  extinct."  Bayle  adds  that  it  is  useful  in 
chronic  gout  and  rheumatism  (which  are  relieved  through  profuse  excre- 
tion of  sweat  or  urine),  and  "  all  morbid  conditions  wherein  it  is  proper 
to  excite  these  secretions,  and  at  the  same  time  to  stimulate  vitality  in 
a  speedy  and  energetic  manner"  ("  Bibliotheque  de  Therapeutique,"  vol. 
ii.). 

Powers  so  extensive  as  these  have  not  been  accorded  to  phosphorus  by 
more  modern  writers,  but  Mr.  Clay  has  illustrated  its  value  in  the  collapse 
of  variola  (Lancet,  ii.,  1858,  p.  315),  and  Dr.  John  Brunton  in  the  adyna- 
mia of  typhus  and  typhoid  fevers,  rapid  improvement  taking  place  under 
drachm-doses  of  the  following  solution:  Tinct.  phosph.  aeth.  (gr.  ^  ad  3  j«) 
3  iij.,  Spt.  vini  rectif.  3  ss.,  Glycerini  ad  §  iss.  About  two  grains  were 
taken  in  the  course  of  two  days. 

I  have  frequently  prescribed  phosphorus  in  the  exhaustion  of  typhus 
and  typhoid,  and  have  sometimes  seen  remarkably  good  results  from  it; 
but,  on  the  other  hand,  have  been  often  disappointed,  and  cannot  but 
consider  it  an  uncertain  remedy  in  such  cases.  I  would  place  more  de- 
pendence upon  ammonia,  camphor,  and  other  stimulants  of  that  class,  but, 
if  they  failed,  should  then  have  recourse  to  phosphorus.  Another  use  of 
the  drug  in  fevers  is  to  assist  development  of  the  specific  eruption,  e.g., 
in  enteric,  scarlet  fever,  and  measles,  and  within  my  own  experience  it  has 
proved  of  service  when  the  eruption  has  disappeared  suddenly  with  the 
onset  of  serious  symptoms. 

Exhaustion  of  Generative  System-^Impotence. — In  such  conditions 
phosphorus  has  long  had  a  reputation,  and  was  much  valued  by  early 
authorities,  but  modern  experience  has  limited  its  powers.  If  the  special 
exhaustion  referred  to  be  only  part  of  a  generally  enfeebled  state,  it  will 
doubtless  improve  as  general  tone  and  vigor  improve,  but  this  system  is 
not  to  be  stimulated  apart  from  the  others;  indeed,  if  it  were- so,  this 
might  be  a  serious  drawback  to  the  ordinary  use  of  the  remedy.  I  may 
say,  however,  that  in  some  of  my  own  cases  an  irritable,  weakly  condition 
VOL.  L— 4 


50 

of  the  sexual  organs,  traceable  to  previous  early  abuses  or  subsequent  ex- 
cesses, has  been  much  benefited  by  steadily  continued  doses  of  ^-JT  to  y^ 
gr.  thrice  daily. 

Spinal  Irritation. — I  consider  phosphorus  of  greater  value  when  this 
condition  is  connected  with  onanism  than  when  arising  from  over-fatigue 

el  O 

or  other  causes.  The  irritation  is  marked  by  local  discomfort,  a  burning 
pain  in  the  lumbar  region,  sense  of  fatigue  and  impaired  walking  power, 
mental  distress,  etc.  In  such  cases  it  is  essential  that  the  patient  exert 
moral  control  over  himself,  and  that  treatment  be  continued  judiciously 
for  some  months.  The  remedy  relieves  the  spinal  pain  and  the  mental 
depression,  and  thus  indirectly  tends  to  lessen  abnormal  sexual  desire. 

disorders  of  Menstruation. — Patients  with  scanty,  watery,  and  ir- 
regular catamenia  sometimes  suffer,  about  the  time  of  the  periods,  from 
sick  headache,  and  when  this  is  the  case  a  continued  course  of  phos- 
phorus increases  the  quantity  and  improves  the  quality  and  regularity  of 
the  menses,  and  the  headaches  frequently  disappear.  Phosphorus,  like 
aconite,  restores  the  discharge  when  suddenly  interrupted  by  cold  or 
fright. 

When  the  discharge  is  not  only  too  profuse,  but  watery  in  character, 
and  rather  delayed  beyond  the  natural  time,  phosphorus  is  of  consider- 
able use,  as  it  checks  the  overflow,  relieves  the  backache,  improves  the 
mental  depression,  removes  the  nausea  and  vomiting  so  frequently  at- 
tendant, and  strengthens  the  general  condition.  It  is  also  useful  in  pro- 
fuse menstruation  attended  with  excessive  sexual  excitement.  The  dose 
should  rarely  exceed  y-J^  gr.  every  two  to  four  hours  during  the  menses, 
and  morning  and  night  during  the  menopause. 

Paralysis. — Cases  of  hemiplegia  relieved  by  phosphorus  are  on  rec- 
ord, but  not  from  very  reliable  sources.  It  is  contraindicated  in  acute 
irritative  conditions,  but  in  chronic  stages  should  be  tried,  particularly 
if  exhaustion  be  a  prominent  symptom.  I  agree,  generally,  with  Le- 
maire,  who  has  summarized  the  modern  use  of  it  for  paralysis,  and  finds 
that,  in  local  palsies  after  severe  illness,  or  from  anaemia  or  hemorrhage, 
it  has  a  general  tonic,  stimulant  power,  but  not  a  specific  curative  effect, 
and  is  always  uncertain.  In  paralysis  dependent  on  severe  organic  dis- 
ease, tumor,  or  hemorrhage  in  the  nerve-centres,  it  cannot,  of  course,  be 
relied  upon,  nor  in  hysterical  palsy,  although,  in  the  last-named,  I  have 
sometimes  seen  advantage  from  it,  and  Dr.  Hammond  speaks  well  of  a 
combination  of  zinc  phosphide  with  strychnia.  It  is  commonly  useless 
in  old  paraplegia,  in  sclerosis,  and  in  lead-palsy;  and  Mr.  Sanger  is 
almost  alone  in  reporting  paraplegia  and  paralysis  agitans  cured  by  the 
drug.  I  have,  however,  known  it  relieve  formication  in  paralyzed  parts. 
It  has  been  found  of  service  in  recent  ataxy  and  in  mercurial  palsy  (tre- 
mor), arid  its  advantage  has  been  distinct  in  functional  derangement 
with  adynamia,  and  in  some  slight  structural  lesions  when  inflammation, 


PHOSPHORUS.  51 

fever,  and  cerebral  excitement  were  absent  (Bulletin  General  de  TJiera- 
peutique,  September,  1875).  The  dose  recommended  is  about  one  milli- 
gramme (^5-  gr.).  For  intra-ocular  paralysis  it  was  used  by  Tavignot, 
externally  and  internally. 

Tremor. — In  alcoholic  tremor,  as  well  as  in  the  mercurial  form,  and 
in  partial  paralysis  of  the  same  kind  caused  by  arsenic,  Dr.  G.  De  Mussy 
has  found  advantage  from  four-milligramme  doses  (-^  gr.)  (Lancet,  i., 
1876). 

Locomotor  Ataxy. — Dujardin  Beaumetz  has  advocated  the  use  of 
phosphorus  in  ataxia,  upon  the  strength  of  four  partially  successful 
cases,  of  which,  however,  the  after-history  is  not  given.  His  favorable 
observations  have  not  been  generally  confirmed,  though  a  patient  said  to 
be  suffering  from  "progressive  locomotor  ataxy,"  unrelieved  by  bro- 
mides, strychnia,  quinine,  and  iron,  was  able  to  stand  and  to  walk  after 
two  months'  treatment  by  phosphuretted  oil  (Hartley:  Lancet,  i.,  1877), 
and  some  other  scattered  observations  may  be  found.  The  malady  ex- 
hibits, in  its  natural  course,  remission  and  improvements,  partial,  and 
lasting  for  a  variable  time,  but  sufficient  to  throw  uncertainty  on  the  ac- 
tion of  any  medicine,  unless  very  carefully  and  frequently  verified.  This 
was  instanced  in  one  of  eighteen  cases  of  ataxy  reported  by  Mr.  Bradley 
(British  Medical  Journal,  ii.,  1878);  the  improvement  observed  might 
have  been  credited  to  the  remedy,  had  not  the  patient  relapsed  after- 
ward while  under  the  same  treatment.  The  others  remained  in  statu 
quo.  It  is  possible  that,  in  these  and  similar  instances,  the  dose  was  too 
large,  or  not  continued  long  enough,  and  further  observations  should  be 
made.  Certainly,  in  some  few  cases  I  have  seen  much  improvement 
during  a  prolonged  use  of  phosphorus  (ifa  gr.)  or  zinc  phosphide, 
though  I  am  not  satisfied  that  it  was  really  due  to  the  drug. 

Hysteria. — Nerve-power  is  impaired  in  this  affection,  the  emotions 
not  being  under  normal  control;  more  or  less  neuralgia  is  often  concomi- 
tant, and  altogether  it  is  a  condition  in  which  we  should  expect  phos- 
phorus to  be  useful,  and  instances  of  its  value  are  on  record.  The  cases 
benefited  by  it  have  been  acute  or  chronic,  dependent  on  sudden  shock, 
or  gradually  coming  on  with  increasing  weakness  and  despondency;  in 
either  form  a  period  of  debility  is  liable  to  be  followed  by  convulsive  at- 
tacks. I  do  not  undervalue  moral  and  hygienic  treatment;  but,  among 
medicines,  phosphorus  in  doses  of  -j-J-^  to  -fa  gr.  has  proved  efficient  in 
my  hands.  When  hysterical  attacks  are  connected  with  delayed  or  sup- 
pressed menses,  pain  in  iliac  and  lumbar  regions,  vomiting,  palpitation, 
and  general  excitement  alternating  with  depression,  I  have  found  this 
remedy  regulate  the  menstrual  periods  and  cure  the  hysterical  symptoms. 

Epilepsy. — In  true  epilepsy  it  has,  like  most  other  nerve-tonics,  been 
used  and  commended,  but  evidence  of  its  really  preventing  the  attacks  is 
contradictory.  Broadbent  found  it  useful  in  epileptiform  vertigo  (Prac- 


52  MATERIA   MEDIC  A    AND    THERAPEUTICS. 

titioner,  viii.-x.),  and  Anstie  observed  it  relieve  the  depression  of  epi- 
leptics and  improve  their  temper  and  power  of  control  (Medical  Times, 
i.,  1862).  In  the  early  period  of  the  disease,  when  dependent  upon  sexual 
abuse,  I  have  known  phosphorus  prove  very  beneficial.  I  remember  es- 
pecially the  cases  of  two  men,  aged  nineteen  and  twenty-three,  whose 
attacks  began  soon  after  puberty,  and  who  had  taken  large  doses  of  po- 
tassium bromide  without  evident  relief,  and  who  became  quite  freed  from 
their  attacks  during  a  course  of  phosphorus,  and  have  continued  free 
from  them  during  the  four  and  six  years  that  have  since  elapsed.  The 
dose  was  only  -j-J-g-  gr.  three  times  daily,  which  was  continued  (irregu- 
larly) for  twelve  or  fifteen  months. 

Melancholia — Dementia. — Dr.  S.  W.  Williams  in  this  country,  and 
Dr.  Ford  in  America,  have  recorded  their  experience  of  phosphorus  in 
these  conditions.  The  six  cases  of  the  former  physician  were  treated  by 
-g^-gr.  doses  (Kirby's  pills)  twice  or  thrice  daily,  but  only  two  could  be 
considered  relieved  (Journal  of  Mental  Science,  1874).  Dr.  Ford  recog- 
nized improvement  in  fifteen  cases  of  dementia  (American  Journal  of 
Insanity,  January,  1874).  Dr.  Judson  Andrews  had  previously  written 
in  favor  of.  phosphoric  acid  in  different  forms  of  insanity,  but  especially 
those  tending  to  melancholia  (American  Journal  of  Insanity,  October, 
1869). 

I  have  notes  of  thirteen  cases  of  recovery  from  this  distressing  affec- 
tion in  patients  between  the  ages  of  thirty-two  and  forty-five  years,  most 
of  whom  showed  well-marked  symptoms,  such  as  despondency  and  de- 
pression, suicidal  impulse,  fear  of  solitude,  loss  of  sleep,  etc. :  they  looked 
haggard,  with  flushed  face,  and  complained  of  cold,  clammy  skin,  vertigo, 
and  various  disturbances  of  the  digestive  system.  In  addition  to  general 
treatment  by  exercise  and  different  forms  of  bath,  and  the  occasional  use 
of  nux  vomica  or  aperients,  I  gave  phosphorus,  at  first  -fa  gr.,  afterward 
rhr  gr->  thrice  daily,  with  the  result  that  all  recovered  in  the  course  of 
two  to  three  months.  My  experience  of  fourteen  other  cases  between 
the  ages  of  thirty-five  and  fifty  shows,  however,  that  it  is  an  uncertain 
remedy,  and  although  quickly  beneficial  in  some  cases,  in  others  it  is  dis- 
appointing. 

Pneumonia. — A  simple  pneumonia  usually  terminates  favorably,  in- 
dependently of  medicine,  and  requires  at  least  no  active  interference; 
but,  under  certain  conditions  and  complications,  phosphorus  has  proved, 
in  my  experience,  a  valuable  adjuvant.  Thus,  if  at  the  commencement 
of  an  attack  adynamia  is  very  pronounced,  this  medicine  is  indicated.  It 
is  curious  that  the  most  amenable  to  its  action  seem  to  be  adult  subjects 
previously  robust,  and  old  persons.  It  is  a  matter  of  common  observa- 
tion that  the  nerve-power  fails  more  rapidly  in  severe  illness  attacking 
such  subjects,  than  it  does  in  the  young  or  the  simply  delicate.  Some 
degree  of  biliary  disturbance  usually  accompanies  the  early  stages  of 


PHOSPHORUS.  53 

pneumonia,  and  so  long  as  this  does  not  assume  a  very  aggravated  form, 
I  have  found  it  a  good  indication  for  phosphorus  treatment,  and  espe- 
cially if  prostration  be  extreme.  Again,  it  is  good  in  ordinary  cases  with 
difficult  muco-sanguineous  expectoration  and  very  marked  lowering  of 
strength  and  evening  exacerbations;  also  in  later  stages,  when  either 
pyrexia  has  subsided  and  the  patient  is  left  very  feeble,  and  does  not 
progress  toward  convalescence;  or  again,  when  red  hepatization  is  com- 
plete, fever  and  prostration  increase,  and  suppuration  is  imminent — 
although,  when  pus  has  actually  formed,  phosphorus  is  contra-indicated. 

Dr.  A.  Thompson,  speaking  highly  of  the  value  of  phosphorus  in 
pneumonia,  remarks  that  success  depends  much  on  the  dose  given,  and 
in  his  opinion  the  better  results  of  older  practitioners  were  traceable  to 
their  use  of  full  doses,  toxic  effects  being  less  known  and  consequently 
less  feared  by  them.  He  says  that  "  no  caution  need  limit  the  quantity 
of  such  a  preparation  as  the  tincture,  the  only  limit  to  be  recognized 
being  improvement  in  the  patient."  He  commonly  orders  -j^-gr.  dose  in 
the  cases  referred  to,  but  I  cannot  agree  either  with  this  theory  or 
practice;  my  best  results  have  been  obtained  with  ^^  to  T^7  or  -£$  gr. 
given  every  two  to  four  hours. 

I  have  also  had  good  results  from  phosphorus  in  chronic  pneumonia; 
but  when  it  occurs  in  tuberculous  subjects  with  tendency  to  hemorrhage, 
this  drug  should  be  avoided.  In  acute  or  chronic  cases,  complicated  with 
bronchitis,  phosphorus  is  less  appropriate  than  other  remedies. 

Chronic  Bronchitis. — In  simple  cases  of  this  affection,  when  patients 
complain  of  a  feeling  of  tension  throughout  the  respiratory  tract,  and  a 
hacking,  dry,  and  exhausting  cough,  phosphorus  is,  however,  often  valu- 
able. 

Pleurisy.  —  In  pleuritis  with  extensive  recurrent  effusion  of  dark, 
bloody-looking  serum  (as  proved  by  aspiration),  in  patients  whose  blood  has 
been  impoverished  by  excessive  and  long-continued  use  of  stimulants,  I 
have  found  phosphorus  as  well  as  arsenic  of  much  use  in  hastening  absorp- 
tion of  the  fluid,  and  giving  tone  to  the  nervous  system. 

Tuberculous  Phthisis. — The  action  of  phosphorus  in  this  affection  can 
only  be  considered  palliative;  but  it  can,  at  least,  moderate  some  trouble- 
gome  and  irritating  symptoms.  I  have  used  it  in  various  doses  in  upwards 
of  eight  hundred  cases  of  which  I  have  record,  and  am  satisfied  that  it 
does  not  cure  advanced  tuberculosis,  but  appears  in  many  cases  to  arrest 
its  progress,  at  least  for  a  time;  also  to  improve  the  condition  of  the 
throat  and  the  voice,  and  to  relieve  the  dry,  harassing  cough,  the  pain 
after  food,  and  even  the  colliquative  diarrhosa  and  night-sweats.  It  has 
also  removed  pleuritic  stitches,  and  seemed  to  strengthen  the  general 
condition;  on  the  other  hand,  its  use  is  not  free  from  danger,  and  requires 
caution,  since  it  may  induce  obstinate  haemoptysis  where  there  is  a  ten- 
dency to  hemorrhage. 


54  MATEKIA   MEDICA    AND   THEEAPEUTICS. 

Chronic  Diarrhoea,  in  children,  with  frequent  watery  evacuations, 
abdominal  pains,  depression,  and  emaciation,  or  the  colliquative  form, 
occurring,  e.g.,  in  phthisical  adults,  has  often  in  my  hands  yielded  quickly 
to  phosphorus.  Sometimes  it  is  well  to  give  a  few  doses  of  Fowler's 
solution  of  arsenic  in  conjunction  with  phosphorus. 

Intestinal  Ulceration. — Phosphorus  is  useful  in  ulceration  of  the  in- 
testinal mucous  membrane,  the  result  of  muco-enteritis,  dysentery,  or 
other  causes,  and  especially  when  considerable  prostration,  restlessness, 
and  emaciation  are  present.  It  is  well,  sometimes,  to  combine  it  with  a 
course  of  arsenic. 

Chronic  Otorrhoea. — In  some  obstinate  cases,  common  in  strumous 
children,  phosphorus  is  very  valuable  in  stopping  the  discharge  and  giving 
nerve-tone  and  strength  to  the  system  generally.  When  glycerin  of 
tannin  and  other  astringents  fail  to  permanently  stop  the  discharge,  a 
course  of  phosphorus,  conjoined  with  the  daily  application  of  the  tannin, 
will  accomplish  a  cure. 

Cutaneous  Diseases. — The  value  of  phosphorus  in  these  maladies  was 
mentioned  by  Cazenave,  and  in  1850  Burgess  recommended  it  in  psoriasis 
and  in  lupus.  More  recently  Dr.  Broadbent,  inquiring  how  far  the  chemical 
analogies  of  drugs  would  guide  to  their  therapeutical  effect,  was  led  to 
use  phosphorus  in  the  same  class  of  cases  as  arsenic,  and  he  recorded  six 
cases  of  eczema  and  six  of  psoriasis  treated  by  the  former  drug.  The 
majority  of  these  were  relieved  or  cured  ("  Clinical  Society's  Transac- 
tions," vol.  iv.). 

Dr.  Eames  also  reported  successful  cases  under  the  same  treatment 
(Dublin  Journal,  January,  1872),  and  Mr.  Squire,  recording  in  detail  the 
course  of  psoriasis  in  a  young  girl,  to  whom  full  doses  (fa  to  \  gr.  per 
diem)  were  given  for  several  weeks,  concludes  that  the  remedy  was  of 
much  advantage,  though  not  wholly  curative  by  itself  (British  Medical 
Journal,  ii.,  1877);  and  it  seems  to  me  that  in  this  case  more  allowance 
should  be  made  for  the  change  of  air  and  diet,  the  girl  having  come  from 
Wales  to  London. 

In  a  case  of  Dr.  Whipham's,  whatever  good  was  obtained  in  the  first 
month  of  treatment  was  lost  in  the  second,  and  in  several  cases  within  my 
own  knowledge — severe  and  chronic  cases,  it  is  true — phosphorus  was 
given  without  benefit.  It  would  seem,  then,  that  it  is  uncertain  as  a 
remedy,  and,  without  denying  its  occasional  power  of  relieving,  I  think, 
with  Erasmus  Wilson,  that  it  is  indicated  rather  for  the  impaired  nerve- 
condition  accompanying  many  skin  disorders  than  for  any  direct  influence 
upon  the  nutrition  of  the  skin. 

Lupus — Scrofuloderma. — In  these  forms  of  depraved  nutrition  theory 
would  suggest  that  phosphorus  might  be  useful,  and  Dr.  Eames  states 
that  some  cases  have  recovered  under  its  use  in  from  five  to  nine  months. 

Dr.  Mackey  has  given  it  a  fair  trial  in  three  or  four  instances  of  various 


PHOSPHOKUS.  55 

forms  of  lupus,  and  has  found  it  improve  the  general  condition,  but  with- 
out exerting  any  special  influence  over  the  local  affection. 

In  rodent  and  cancerous  ulceration,  however,  I  have  known  it  relieve 
the  burning  and  other  pains,  and  also  check  discharge  and  lessen  exhaus- 
tion. V 

Pemphigus — Acne — Soils. — Cases  of  cure  from  each  of  these  disor- 
ders, under  the  use  of  phosphorus,  have  been  recorded  (British  Medical 
Journal,  ii.,  1876).  In  pemphigus,  arsenic,  as  a  rule,  is  to  be  preferred, 
and  during  an  eruption  of  boils,  phosphorus  is  only  indicated  if  the  pus 
becomes  thin  and  sanious,  and  the  nerve-power  unusually  depressed. 

A  severe  case  of  acne  indurata  under  Dr.  Eames  seems  to  have  im- 
proved remarkably,  but  the  few  cases  in  which  I  have  used  it  did  not 
derive  benefit  from  it. 

Abscess  (Fetid). — In  simple  cases  of  abscess,  antiseptic  surgery,  care- 
fully carried  out,  generally  proves  successful;  but,  should  it  not  do  so,  and 
should  the  pus  become  fetid  and  watery,  and  hectic  fever  appear,  with 
rapid  failure  of  strength,  then  T^g-  to  ^  gr.  phosphorus  should  be  given 
every  two  to  four  hours,  and  1  have  seen  this  produce  most  favorable 
results. 

JBone  Disease — Rachitis — Fracture. — In  cases  of  fracture,  resection, 
and  transplanting  of  periosteum,  Wegner  found  that  small,  continued 
doses  of  phosphorus  stimulated  the  growth  of  new  bone,  especially  in 
young  animals;  also  that  ossification  in  the  fcetus  was  promoted  by  giv- 
ing phosphorus  to  the  mother.  It  is  noteworthy  that  he  obtained  similar 
results,  though  less  in  degree,  from  phosphoric  acid  and  oxy -compounds 
of  phosphorus,  but  not  from  the  amorphous  element,  nor  from  lime  phos- 
phate. 

I  have  myself  seen  good  results  from  phosphorus  in  ordinary  caries  of 
bone,  and  again,  in  cases  of  abscess  connected  with  necrosed  bone,  it  les- 
sens suppuration  and  hastens  the  separation  of  the  sequestrum;  given 
during  pregnancy,  it  relieves  the  dental  caries  and  neuralgia  often  inci- 
dental to  that  state,  and  I  have  given  the  hypophosphites  successfully  in 
such  cases.  It  may  be  presumed  that  phosphorus,  and  such  preparations 
of  it,  would  also  improve  the  nutrition  of  the  fcetus  in  weakly  subjects, 
and  I  think  they  might  often  be  used  with  advantage  in  chronic  rachitis. 

Leucocythcemia  —  Pernicious  Anaemia  —  Lymphadenoma. — It  is  in 
such  blood — and  gland — disorders,  which  are  essentially  of  serious,  if  not 
fatal  import,  that  phosphorus  has  been  recently  employed,  and  Dr.  Broad- 
bent,  one  of  the  first  to  recommend  it,  offered  some  evidence  in  its  favor. 
A  boy  with  "  essential  anaemia,"  prostration,  diarrhoea,  yellow,  waxy  face, 
etc.,  recovered  very  quickly  under  phosphorus  capsules,  and  remained 
well  for  some  time.  Another  case  of  "  leucocythasmia,"  treated  in  the 
same  manner,  got  inflamed  spleen,  "  apparently  from  very  rapid  blood- 
formation  "  (Practitioner,  i.,  1875).  In  a  woman  with  lymphadenoma, 


56  MATERIA    MEDIC  A    AND    THERAPEUTICS. 

having  symmetrical  enlargement  of  cervical  glands,  anaemia,  dyspnoea, 
etc.,  steadily  getting  worse  for  some  time,  "  complete  recovery  took 
place"  after  taking  phosphorus  (British  Medical  Journal,  ii.,  187G,  p. 
792).  In  two  other  cases — one  very  far  advanced,  the  other  chronic — the 
same  remedy  was  successful.  Some  support  w.as  given  to  Dr.  Broadbent's 
conclusions  by  a  case,  under  Dr.  Wilson  Fox,  of  "leukaemia  splenica" 
occurring  in  a  man,  aged  thirty-seven,  in  University  College  Hospital,  for, 
when  extremely  enfeebled,  he  began  to  take  -fa  to  -^  gr.  doses,  and  after 
three  months'  treatment  was  greatly  improved;  he  died,  however,  in  the 
following  year  (Lancet,  ii.,  1875). 

If  we  add  to  these  cases  one  of  leukaemia  (Dr.  Gowers),  in  which  the 
use  of  phosphorus  was  followed  by  diminution  in  size  of  glands,  and  les- 
sened anaemia  (though  albuminuria  and  death  afterward  occurred),  it  will 
be  seen  that  the  evidence  in  favor  of  phosphorus  is  not  strong,  while 
many  cases  of  its  failure  are  on  record.  Dr.  Moxon  objects  even  to  re- 
ceive Dr.  Fox's  successful  case  as  one  of  leukaemia,  because  the  white  cor- 
puscles in  the  field  were  "  only  twenty  to  thirty,"  and  refers  to  about 
thirty  cases  of  his  own  ("  pernicious  anaemia,"  apparently),  all  unsuccess- 
fully treated  by  phosphorus  (British  Medical  Journal,  ii.,  1876,  p.  792). 

At  the  meetings  of  the  Clinical  Society  at  which  this  subject  was  dis- 
cussed (November,  1876),  Dr.  Greenfield  and  Dr.  Goodhart  related  unsuc- 
cessful cases,  and  Sir  William  Jenner  referred  to  three  of  "  splenic  leuco- 
cythaemia,"  in  which  the  remedy  seems  to  have  had  a  really  fair  trial  with- 
out any  good  result.  The  question  was  even  raised  whether  it  might 
not  be  responsible  for  some  fatty  degeneration  found  post-mortem;  but, 
without  laying  stress  upon  that  point,  the  general  conclusion  of  compe- 
tent authorities,  both  at  that  time  and  since,  has  been  adverse  to  the 
value  of  phosphorus  in  such  cases. 

It  would  seem,  perhaps,  to  offer  a  better  prospect  in. cases  of  tympha- 
denoma  than  of  leukaemia,  and  especially  in  early  cases,  and  more  evidence 
must  be  collected  before -we  can  rightly  estimate  the  true  power  of  the 
drug.  I  have  already  referred  to  the  increase  of  red  blood-corpuscles,  re- 
ported by  Dr.  Gowers,  under  the  use  of  phosphorus;  this  was  in  a  case 
of  "  lymphoma,"  and  the  increase  in  one  month  was  from  52  to  66  per 
cent.,  and  in  another  month  to  74  per  cent. ;  ^  gr.  was  taken  three  times 
and  then  six  times  daily — no  other  drug  was  given,  nor  were  the  circum- 
stances of  the  patient  altered.  The  pathology  of  these  maladies  is,  how- 
ever, still  very  obscure,  and  they  are  not  well  defined  one  from  the  other. 
Greater  clearness  in  their  diagnosis  and  prognosis  must  be  expected  to 
precede  therapeutic  advance;  but  we  may  say  this,  that  much  more  bene- 
fit has  been  already  recorded  from  arsenic,  both  in  pernicious  anaemia  and 
in  lymphadenoma,  than  from  phosphorus.  The  two  remedies  are  doubt- 
less allied,  but  the  former  claims  much  more  reliance  than  the  latter. 

Bronchocele. — In  nine  cases  of  bronchocele  (fibrous)  I  have  made  trial 


PHOSPHORUS.  57 

of  phosphorus  in  varied  doses,  but  without  good  result.  Dr.  Leech  (Man- 
chester) has  sometimes  seen  the  growth  subside  under  the  use  of  this 
drug,  after  iodine  had  failed  (British  Medical  Journal,  i.,  1874),  and  it 
may  occasionally  prove  a  resource.  Dr.  Moxon  has  pointed  out  that 
glandular  tumors  vary  in  size,  not  only  under  various  remedies,  but  some- 
times without  apparent  cause. 

PREPARATIONS  AND  DOSE. — Phosphorus :  dose,  T^  to  -fa  gr.,  less  or 
more.  Oleum  phosphor atum  (made  with  oil  of  almonds  previously  heated 
to  300°  F.,  to  destroy  organic  impurities);  5  min.  contain  -£%  gr. :  dose,  3 
to  10  min.  Pilula phosphori  (made  with  tolu  and  yellow  wax);  5  gr.  of 
the  pill  contain  -fa  gr. 

An  exception  has  been  taken  to  these  officinal  preparations:  to  the 
oil  as  disagreeing  with  the  stomach,  to  the  pill  as  being  too  concentrated, 
or  not  soluble  enough;  and  many  other  formulae  for  the  medicine  have 
been  published  (British  Medical  Journal,  i.,  1879,  etc.).  It  is  commonly 
agreed  that  the  free  unoxidized  element  will  produce  effects  which  none 
of  its  chemical  compounds  can  do,  and  it  is  desirable,  therefore,  to  give 
it  in  its  pure,  unaltered  state.  It  cannot  be  finely  divided  without  risk  of 
oxidation,  and  the  vehicles  of  fluid  preparations,  especially  oils,  are  apt  to 
disagree  with  the  stomach. 

Devergie,  Solon,  and  others  state  that  a  solution  in  any  vegetable  oil, 
exposed  to  light  and  air,  is  apt  to  decompose,  with  partial  conversion  of 
the  element  into  hypophosphorous  acid,  which  has  toxic  properties,  and 
hence  some  untoward  accidents  that  have  occurred  with  the  phosphorated 
oil.  A  solution  in  cod-liver  oil  is  not  liable  to  this,  but  Dr.  Broadbent 
finds  it  soon  becomes  oxidized,  and  loses  its  effect. 

An  alcoholic  tincture  may  be  prepared  by  adding  phosphorus  in  excess 
to  boiling  alcohol  quite  free  from  water;  this  will  take  up  1  gr.  in  6  dr. 
20  min.  (Thompson),  and,  if  carefully  kept  from  light  and  air,  will  remain 
unchanged  for  some  weeks.  As  the  result  of  many  observations,  Dr.  A. 
Thompson  recommends  3  dr.  10  min.  of  this  tincture  (=£gr.  phosphorus) 
to  be  added  to  1  oz.  40  min.  of  anhydrous  glycerin,  with  5  min.  of  spt. 
peppermint,  and  he  finds  this  more  stable  and  less  disagreeable  than  any 
other  form. 

I  myself  prefer  an  ethereal  tincture,  in  which  1  gr.  phosphorus  is  first 
dissolved  in  1  dr.  of  pure  ether;  and  this  solution,  after  standing  some 
days,  is  mixed  with  pure  alcohol,  so  that  a  proportion  of  1  gr.  in  500 
min.  is  preserved.  From  2£  to  5  or  10  min.  of  this  (^<r  to  T^-JJ-  or  -fa  gr.) 
are  readily  taken,  mixed  with  water,  and  the  preparation  is  stable  enough 
for  all  practical  purposes.  It  should  not  be  kept  longer  than  three  to 
five  weeks. 

CMoroform,  which  dissolves  1  per  cent,  rather  quickly,  has  been  used 
by  M.  Beaumetz  as  a  vehicle,  in  capsules  or  in  wine;  but  it  is  nauseous, 
and  not  well  borne.  Bisulphide  of  carbon  is  really  the  best  solvent  yet 


58  MATERIA    MEDICA    AND    THERAPEUTICS. 

known  for  phosphorus,  but  its  depressant  and  sometimes  toxic  effects 
centra-indicate  its  use.  Water  will  take  up,  after  agitation,  a  minute  but 
uncertain  amount  of  phosphorus,  and  it  is  not  practically  available  as  a 
medium  for  it.  Capsules  or  "  perles,"  containing  -^  to  -fa  gr.  in  the  form 
of  phosphorated  oil,  are  carefully  prepared  by  Morson  and  other  eminent 
pharmacists,  and  have  been  preferred  by  many  physicians.  They  should 
be  given  after  meals,  but,  even  so,  are  not  free  from  risk  of  causing  gas- 
tric irritation,  fills  may  be  made  either  with  the  drug  reduced  and 
powdered,  or  with  a  solution.  Mr.  Batten  recommends  pills  with  white 
wax;  Mr.  Gerrard  with  resin;  Dr.  Radcliffe  uses  suet.  I  do  not  like  the 
pilularform;  but,  if  it  be  adopted,  oleum  theobromae  is  the  best  medium, 
though  not  easy  to  manipulate  (Martindale). 

The  phosphide  of  zinc  is  a  good  form  for  administering  in  pill.  Lem- 
onade should  be  given  at  the  same  time.  Dose:  fa  gr.  to  £  gr.  The 
latter  dose  may  nauseate. 

[None  of  the  foregoing  preparations  have  as  yet  been  admitted  into 
the  U.  S.  Pharmacopoeia.] 


IODUM—  IODINE,  I,  = 

Iodine  occurs  in  the  form  of  iodide,  with  magnesium  and  sodium,  in 
sea-water,  and  in  many  mineral  waters,  such  as  those  of  Kreuznach,  Cau- 
terets,  etc.;  also  in  sponges  and  sea-weeds,  in  water-cress,  beans,  potatoes, 
etc.  Molluscs,  and  the  liver  of  the  cod  and  other  fish,  contain  iodine,  and 
in  the  human  organism  minute  quantities  are  commonly  found. 

PREPARATION.  —  Iodine  is  prepared  from  kelp,  the  residue  of  burnt 
sea-  weed,  soluble  iodides  being  extracted  by  water,  treated  with  sulphuric 
acid,  and  distilled  with  manganese  oxide.  Free  iodine  volatilizes  and  is 
condensed  in  receivers  —  2HI  (hydriodic  acid)  +  MnOa+H4SO4=MnSO4  + 


CHARACTERS  AND  TESTS.  —  Iodine  forms  heavy,  dark,  glistening  scales, 
which  stain  yellow  or  brown,  and  have  a  peculiar,  irritating  odor.  It  is 
volatile,  rising  in  violet-purple  vapor  at  400°.  The  sp.  gr.  of  this  vapor  is 
8.7,  that  of  the  crystals  4.9.  It  is  soluble  in  alcohol,  ether,  and  chloroform, 
and  in  water  containing  salt  or  iodide  of  potassium,  but  very  slightly  sol- 
uble in  pure  water  (1  part  in  7,000).  The  best  test  for  free  iodine  is 
starch  solution,  which  forms  with  it  a  dark  blue  iodide.  In  testing  an 
alkaline  iodide,  nitric  acid  or  solution  of  chlorine  must  be  added  before 
the  starch,  which  should  be  cold,  for  the  iodide  loses  its  color  on  heating. 
The  addition  of  caustic  alkali  also  decolorizes  the  solution,  iodide  and 
iodate  of  the  alkali  being  formed—  61  +  6KHO  —  5KI  +  KIO3  +  3HaO.  Io- 
dine is  closely  related,  chemically,  to  bromine  and  chlorine  (Halogens). 


IODINE.  59 

It  has  a  stronger  affinity  for  oxygen  than  these  latter;  but,  for  all  other 
elements  besides  oxygen,  a  weaker  affinity. 


COMPOUNDS  or  IODINE. 
POTASSII  IODIDUM— IODIDE  OF  POTASSIUM,  El,  =166. 

PREPARATION. — (1)  By  adding  iodine  to  liquor  potassse  in  slight  ex- 
cess, as  indicated  by  a  pale  brown  color  of  the  solution.  (2)  The  result- 
ing mixture  of  iodide  and  iodate  of  potash  is  then  heated  with  finely 
powdered  charcoal,  which  deoxidizes  the  latter  salt,  so  that  iodide  only 
remains:  it  is  dissolved  out  and  crystallized. 

(1)  6KHO  +  6I=:5KI+KIOs  +  3HaO. 

(2)  KIO,+CS=KI+3CO. 

CHARACTERS  AND  TESTS. — Occurs  in  white  crystals,  usually  cubical 
and  opaque,  but  sometimes  octahedral  and  transparent.  When  pure 
these  are  odorless,  but  they  commonly  have  some  scent  of  free  iodine, 
and  if  this  is  present  they  are  tinged  more  or  less  yellow.  The  taste  is 
saline.  It  is  very  soluble  in  water  and  in  six  parts  of  rectified  spirit. 
Nitrate  of  silver  precipitates  a  pale  yellow  iodide  of  silver,  insoluble  in 
ammonia.  If  this  liquid  be  then  acidified  with  nitric  acid,  no  precipitate 
should  occur;  if  it  does  occur,  chlorides  are  present.  The  most  important 
adulteration — not,  however,  a  very  frequent  one — is  the  iodate  of  potash, 
and  this  is  detected  by  its  insolubility  in  rectified  spirit,  and  also  by  the 
blue  color  developed  on  adding  prepared  starch  and  a  little  acid,  e.g.,  tar- 
taric. 

SODII  IODIDUM— AMMON1I  IODIDUM  (not  officinal). 

The  iodides  of  sodium  and  of  ammonium  are  prepared  in  a  similar 
manner  to  the  last  described,  and  have  similar  characters,  and  may  be 
tested  in  the  same  way. 

10DOFORMUM—IODOFORM,  CHI3,=394  (not  officinal), 

Is  a  teriodide  of  formyl,  and  may  be  prepared  by  adding  chlorinated  lime 
to  an  alcoholic  solution  of  iodine,  heated  to  104°  F.,  till  the  liquid  ceases 
to  assume  a  red  color.  Confused  crystalline  masses  of  iodate  of  lime  and 
iodoform  precipitate  on  cooling;  the  latter  is  dissolved  out  by  boiling 
alcohol,  and  deposited  in  small,  pearly,  yellow  crystals  of  sweetish  taste 
and  penetrating,  characteristic  odor.  It  is  insoluble  in  water,  but  soluble 
in  boiling  spirits  (10  parts),  ether  (20  parts);  also  in  chloroform,  bisul- 
phide of  carbon,  and  oils;  partially  volatilized  by  heat;  contains  nine- 
tenths  of  its  weight  of  iodine  (Bouchardat). 


60  MATERIA    MEDICA    AND    THERAPEUTICS. 

ABSORPTION  AND  ELIMINATION. — Iodine  may  be  absorbed  to  some 
extent  by  the  unbroken  skin,  if  the  local  inflammation  excited  be  not  too 
severe.  A  dilute  solution  is  therefore  better  absorbed  than  a  strong:,  ir- 

O? 

ritant  tincture.  M.  See  maintained  that  the  unbroken  skin  would  not 
absorb  iodine  at  all,  and  that  any  systemic  effects  following  its  applica- 
tion were  due  to  absorption  of  the  vapor  by  the  lungs  (Medical  Times,  i., 
1874),  but  I  believe  the  facts  are  as  above  stated.  If  a  limb  be  painted 
with  tincture  of  iodine,  and  covered  with  oil-silk,  drops  of  colorless  liquid 
may  be  found  upon  it  after  a  few  hours;  this  liquid  contains  the  drug 
altered  in  some  way  by  the  perspiration  (Gubler),  and  a  similar  alteration 
possibly  occurs  before  its  absorption.  The  drug  may  certainly  be  ab- 
sorbed by  the  skin  in  a  bath  containing  iodine  and  iodide  of  potassium; 
nor  is  there  any  question  as  to  its  free  absorption  from  serous  and  mu- 
cous membranes.  Iodide  of  potassium  and  other  alkaline  iodides  are  not 
absorbed  as  such,  even  when  applied  to  the  skin  continuously  in  lotion  or 
ointment;  but,  after  being  decomposed  by  the  acids  of  the  perspiration, 
or  of  lard,  etc.,  they  evolve  free  iodine,  which  may  be  absorbed,  as  proved 
by  its  appearance  in  the  urine  (Rabuteau).  Iodide  of  ammonium  is  the 
alkaline  salt  most  readily  decomposed,  but  iodoform  parts  with  its  iodine 
still  more  readily  (Lancet,  i.,  1863).  Baehrach  applied  compresses  with 
iodate  of  potash  solution,  2^  per  cent.,  to  the  limbs,  and  in  healthy  sub- 
jects found  iodine  in  the  urine  after  fifteen  minutes — in  fever  patients 
only  after  an  hour  or  more  (  Centralblatt  filr  Medicin,  ii.,  1879).  By 
mucous  surfaces  these  compounds  are  easily  absorbed;  thus,  when  a  sup- 
pository containing  20  gr.  of  iodide  of  potassium  was  placed  in  the  va- 
gina, 18  gr.  were  absorbed  in  twelve  hours;  glycerin  diminished  the  rate 
of  absorption,  while  a  little  free  iodine  increased  it  (liritish  Medical 
Journal,  i.,  1878,  p.  897).  Serous  membranes  absorb  iodides  still  more 
rapidly. 

Taken  into  the  stomach  in  small  or  moderate  doses,  iodine  coagulates 
and  combines  with  albuminous  material,  and  is  probably  taken  up  in  part 
as  an  albuminate,  though  a  larger  proportion  combines  with  the  soda  of 
the  gastric  juice,  and  becomes  iodide  of  sodium  before  being  absorbed. 
Rabuteau  thinks  this  combination  with  sodium  occurs,  to  some  extent,  in 
the  blood. 

Alkaline  iodides  are  either  absorbed  unchanged,  or  as  iodide  of  so- 
dium. 

Hogyes  has  recently  published  observations  on  the  absorption  of  iodo- 
form. He  states  that,  if  introduced  in  an  undissolved  condition,  the  first 
step  is  its  solution  in  whatever  fatty  matter  may  be  at  hand,  e.g.,  the 
chyme  in  the  intestine,  and  oily  constituents  of  organic  liquids  in  subcu- 
taneous tissue  and  serous  cavities.  The  oily  solution  of  iodoform  next 
gives  up  its  iodine  to  any  albuminous  principle  present.  The  iodide  of 
albumen  thus  produced  is  speedily  taken  up  into  the  blood,  while  a  few 


IODINE.  61 

minute  coagula  and  oil-globules  are  left  behind.  The  iodine  is  gradually 
eliminated  from  the  system  in  combination  with  potassium  or  sodium  (Ar- 
chiv  fur  Exp.  Pathologie  und  Pharmak.,  Bd.  x.,  Hft.  3,  4). 

Metallic  iodides,  such  as  those  of  iron,  lead,  or  mercury,  are  decom- 
posed, and  also  form  iodide  of  sodium,  which  appears  in  the  urine,  while 
the  metal  passes  by  the  bowel,  or  is  deposited  Tn  the  tissues.  Absorp- 
tion of  iodides  seems  to  be  markedly  promoted  by  ozonic  ether  (Day: 
Medical  Times,  i.,  1871),  by  ammonia,  and  some  other  stimulants.  Both 
iodine  and  the  alkaline  iodides  are  readily  and  rapidly  eliminated  by  the 
different  secretions,  and  may  be  detected  in  the  saliva,  the  buccal  and  bron- 
chial mucus,  the  tears,  the  milk,  the  perspiration,  the  urine,  etc.  R.  W. 
Taylor  has  reported  evidence  of  elimination  of  iodine  by  the  skin  in  the 
case  of  a  man  with  pityriasis,  who  took  large  doses  of  the  potassium  salt 
while  wearing  a  starched  shirt;  he  had  profuse  perspirations,  and  a  dark 
coloration  appeared  on  his  back.  After  continued  use  of  iodoform  inter- 
nally, iodine  is  clearly  eliminated  by  the  skin,  as  proved  by  the  charac- 
teristic and  unpleasant  odor  of  the  perspiration  (Binz). 

It  would  seem  that  almost  all  the  iodine  taken  passes  by  the  urine,  for 
Scharlau  recovered  from  that  excretion  345  centigrammes  out  of  350  taken 
(Stille).  According  to  Melsens,  very  little  can  be  traced  in  the  faeces;  he 
suggests  that  the  iodine  that  is  excreted  into  the  intestine  is  taken  up 
again  by  the  lining  membrane  before  it  reaches  the  rectum.  Rabuteau 
found  a  small  quantity  in  the  fasces,  so  long  as  it  was  present  in  the  other 
secretions;  if  diarrhoaa  occurred,  the  quantity  was  notably  increased. 

The  rapidity  of  elimination  varies  with  the  quantity  taken,  a  large 
dose  giving  evidence  of  its  passage  very  quickly.  Ranke  found  traces 
in  the  urine  three  and  a  half  minutes  after  administration,  and  even 
sooner  in  the  saliva.  Nothnagel  also  found  it  early — in  ten  minutes  in 
the  latter  secretion.  Richardson  found  it  in  the  urine  within  one  minute 
of  injecting  tincture  of  iodine  into  an  enlarged  bursa,  and,  three  minutes 
after  breathing  iodide  of  ethyl,  iodine  could  be  detected  in  the  urine.  It 
is  an  important  practical  point  that  elimination  of  this  drug  is  complete 
sooner  than  that  of  many  others.  Dr.  Balfour  noted  that  even  if  large 
doses  of  iodide  of  potassium  had  been  taken  for  many  weeks,  their  elimi- 
nation was  complete  within  three  or  four  days  after  ceasing  to  take  them 
(Edinburgh  Medical  Journal,  1868).  Dr.  Duckworth,  after  a  dose  of  4 
gr.,  found  iodine  in  the  saliva  in  five  minutes,  in  the  urine  in  twenty-five 
minutes;  after  twelve  hours'  interval  it  was  still  to  be  detected  in  both 
secretions,  but  after  thirty-six  hours  in  neither  ("  Bartholomew  Hospital 
Reports,"  vol.  iii.).  Rabuteau,  after  15  gr.,  found  traces  in  the  urine 
for  three  days;  after  150  gr.,  for  ten  days;  not  afterward.  The  greater 
part  was  eliminated  during  the  first  day,  little  passed  on  the  second,  and 
scarcely  a  trace  on  the  third;  in  the  dog,  elimination  was  somewhat 
slower.  Claude  Bernard,  giving  iodide  of  potassium,  ceased  to  find  it  in 


62 

the  urine  twenty-four  hours  afterward;  that  he  detected  it  in  the  saliva 
for  three  weeks  must  be  considered  exceptional.  Speck  has  stated  that  in 
Bright's  disease  the  kidneys  do  not  eliminate  iodine,  and  Dr.  Duckworth 
could  not  detect  it  in  one  case  after  giving  10  min.  of  the  compound 
tincture;  but  3  gr.  of  the  iodide  of  potassium  gave  evidence  of  its  pres- 
ence, only  much  later  than  usual,  namely,  one,  two,  or  three  hours  after 
administration.1  Baehrach,  giving  moderate  doses  of  iodate  of  potash  by 
the  mouth  to  healthy  subjects  and  to  fever  patients,  traced  the  drug  in 
the  urine  of  both  within  fifteen  minutes;  but,  on  injecting  it  under  the 
skin,  elimination  in  the  former  occurred  in  five  minutes,  but  in  the  latter 
forty  minutes  later  (loc.  cit.). 

As  will  be  noticed  again  under  therapeutical  action,  iodides  have  a 
remarkable  power  of  eliminating  with  themselves  various  metals  and  pos- 
sibly organic  poisons  previously  circulating  in  the  blood  or  deposited  in 
the  tissues. 

PHYSIOLOGICAL  ACTION  (EXTERNAL). — Locally  applied,  iodine  in  tinc- 
ture, or  strong  aqueous  solution,  acts  as  an  irritant  or  caustic.  It  stains 
yellowish  brown,  permeates  and  destroys  the  epidermis,  and,  if  it  reaches 
the  true  skin,  causes  severe  heat  and  prickling,  sometimes  serous  effusion 
and  vesication,  followed  by  desquamation  or  superficial  scarring. 

Volkmann  and  Schede  found  that,  a  few  hours  after  the  application  of 
iodine,  the  white  blood-corpuscles  had  escaped  from  the  neighboring  ves- 
sels to  such  an  extent  as  to  give,  under  the  microscope,  an  appearance  of 
suppuration;  disintegration  and  fatty  degeneration  of  tissue-elements  also 
occurred,  and  prolonged  applications  to  the  limbs  of  rabbits  caused  peri- 
ostitis. Iodine  has  -marked  antiseptic  and  antizymotic  power,  and  is 
fatal  to  the  lower  forms  of  life,  both  animal  and  vegetable. 

Its  vapor  when  inhaled,  undiluted  and  in  sufficient  quantity,  causes 
heat,  irritation,  and  cough,  and  sometimes  has  occasioned  bronchitis  and 
haemoptysis. 

Frictions  with  iodide  of  potassium  sometimes  produce  local  irritation 
and  an  acneiform  eruption. 

It  has  been  stated  that  iodoform  does  not  cause  local  irritation,  but  I 
have  known  it  to  do  so  when  applied  to  abraded  surfaces,  especially  in- 
flamed ulcers;  in  ordinary  cases  it  has  some  anaesthetic  effect. 

PHYSIOLOGICAL  ACTION  (INTERNAL). — Mucous  Membranes. — The  ear- 
liest and  most  marked  evidence  of  the  constitutional  action  of  iodine, 
whether  taken  by  the  mouth  or  injected  hypodermically,  is  furnished  by 
irritation  and  catarrh  of  the  mucous  membranes.  If  iodine  itself  be  used, 
as  in  the  form  of  tincture,  there  is  more  liability  to  local  irritation  of  the 

1  Iodine  may  be  detected  in  any  secretions  by  white  starched  paper,  which  should 
be  moistened  with  the  liquid  and  then  touched  with  nitric  acid  containing  some  nitrons 
acid  :  blue  iodide  of  starch  will  be  developed. 


IODIKE.  63 

mouth  and  stomach  than  with  the  alkaline  iodides,  but  the  distal  mucous 
irritation  is  the  same  with  all  forms  of  the  drug.  It  is  shown  mostly  in 
the  throat  and  bronchi,  the  nose  and  eyes — parts  that  are  all  exposed  to 
contact  with  carbonic  acid  gas,  which  it  is  supposed  decomposes  the  iodide 
salt  as  it  is  eliminated,  so  that  free  iodine  exerts  its  local  irritant  effect 
(liabuteau).  Others  trace  a  similar  decomposition  to  contact  with  ozone 
in  the  blood  or  in  the  air  (Buchheim  and  Kammerer:  VirchowV^rcAiu). 
The  irritation  shows  itself  by  pain  and  sense  of  pressure  over  the  frontal 
sinuses,  oedema,  prickling,  and  heat  about  the  nose  and  eyes,  with  sense 
of  stuffiness  and  serous  discharge  like  that  of  ordinary  coryza.  The  dose 
that  will  produce  these  symptoms  varies  much  with  different  persons, 
some  being  acutely  affected  by  1  or  2  gr.,  others  not  by  10  or  even  20 
gr.  continued  daily  for  a  long  time. 

Circulatory  System. — Iodine  and  iodides,  especially  the  former,  stim- 
ulate this  system,  rendering  the  pulse  fuller  and  more  frequent,  dilating 
the  capillaries,  and  increasing  heat  in  the  extremities. 

After  toxic  doses,  first  palpitation  and  flushings,  afterward  faintness, 
pallor,  and  collapse  occur,  and  Benedict  concluded,  from  observations 
on  batrachia,  that  both  cardiac  action  and  respiration  were  paralyzed 
(Schmidt's  Jahrb.,  Bd.  cxv).  Hogyes  reports  a  similar  conclusion  as  to 
the  action  of  iodoform  on  dogs,  cats,  and  rabbits  (Medical  Record,  May, 
1879). 

The  blood  itself  does  not  seem  to  be  affected  unless  it  be  rendered 
more  fluid,  and  disposed  to  exude,  for  a  form  of  purpura — "  iodic  pur- 
pura  " — has  sometimes  occurred  under  the  use  of  iodide  of  potassium. 

Dr.  T.  C.  Fox  records  an  illustration  in  an  adult  with  syphilide,  and 
convalescent  from  rheumatic  fever.  After  the  second  dose  of  5  gr.,  a  co- 
pious eruption  of  purpura  came  out  on  the  arms  and  legs;  this  gradually 
faded  and  again  recurred  while  the  medicine  was  continued.  The  erup- 
tion came  again  under  each  of  the  alkaline  iodides,  especially  the  ammo- 
nium salt;  iodism  occurred  at  the  same  time,  but  the  syphilide  got  well; 
there  was  no  evidence  of  renal  or  other  organic  disease  (British  Medical 
Journal,  i.,  1879).  Dr.  Stephen  Mackenzie  attributed  fatal  purpura  in 
an  infant  to  one  dose  of  2£  gr.  of  the  same  medicine,  but,  in  his  case,  the 
sequence  is  not  so  clear  as  in  some  others  alluded  to  by  him  (British 
Medical  Journal,  i.,  1878).  Dr.  G.  Thin,  after  microscopic  examination 
of  eruptions  caused  by  iodide,  asserts  that  the  neighboring  capillaries  are 
blocked  and  their  walls  altered,  but  the  patient  from  whom  the  speci- 
mens were  taken  was  syphilitic  (Medico-  Chirurgical  Transactions,  1879). 

Whatever  the  pathological  processes  may  be,  I  am  satisfied  that  tinc- 
ture of  iodine  is  liable  to  cause  hemorrhage  from  various  organs,  espe- 
cially in  phthisical  subjects,  and  in  those  with  uterine  congestion.  Kness 
has  observed  hemorrhage  from  the  lungs  and  uterus  in  poisoning  by  iodide 
of  potassium  (British  Medical  Journal,  i.,  1879),  and  extravasations  of 


64  MATERIA   MEDICA    AND   THERAPEUTICS. 

blood  have  been  found  post-mortem  in  animals  poisoned  by  iodoform 
(Medical  Record,  May,  1879,  182).  We  are  not  yet  able  to  reconcile 
this  hemorrhagic  tendency  with  the  clinical  results  obtained  in  the  treat- 
ment of  aneurism  by  iodide  of  potassium. 

Nervous  System. — Much  disturbance  of  the  nervous  system  sometimes 
follows  the  full  action  of  iodine.  It  is  marked  at  first  by  excitement,  with 
restlessness,  tremor,  anxiety,  and  insomnia;  but  this  state  is  liable  to  be 
succeeded  by  feebleness  and  depression.  Toxic  doses  have  caused  violent 
headache,  and  sometimes  convulsion.  Rilliet  described  neuralgia,  tinni- 
tus, disturbed  intellect,  and  convulsion,  as  prominent  symptoms  in  some 
cases  of  iodism.  Altered  vision  and  paralysis  were  noted  by  Brodie. 
"Occasional  hypersesthesia  and  temporary  palsy  of  lower  extremities" 
occurred  in  a  man  who  was  taking  very  large  doses  (90  gr.  thrice  daily) 
of  iodide  of  potassium  (S.  A.  Lane:  Lancet,  ii.,  1873).  Such  symptoms, 
however,  must  be  considered  rare.  H.  Wood  states  that  he  has  only  seen 
the  nervous  system  affected  once,  in  his  experience,  even  "  with  enormous 
doses,"  and  then  the  patient,  who  had  been  taking  270  gr.  daily,  became 
"  intensely  sleepy  and  stupid,"  as  if  under  the  influence  of  bromide. 

More  complete  observations  have  been  made  upon  the  action  of  iodo- 
form on  the  nervous  system.  Maitre  compared  the  effects  to  those  of 
alcohol.  After  moderate  doses — -J  to  1  gramme — a  dog  either  lay  at  rest, 
or,  if  made  to  rise,  staggered  and  fell;  next  day  it  seemed  well.  After  3 
or  4  grammes,  intense  excitement  set  in,  with  quickened  circulation,  con- 
vulsive contraction  of  limbs,  and  opisthotonos  like  that  of  strychnine. 
These  are  symptoms  as  of  iodine  in  the  circulation,  and  the  odor  of  this 
substance  was  strongly  marked  in  the  breath.  It  would  seem  that,  when 
not  dissolved  in  the  blood,  iodoform  acts  as  an  irritant  on  the  nervous 
system,  but  when  completely  soluble  it  induces  muscular  relaxation  with 
insensibility  (acting  like  a  narcotic).  Maitre  was  one  of  the  first  to  re- 
cord its  power  of  relieving  nerve-pain  (Bouchardat:  Ann.,  1857).  Righini, 
considering  its  chemical  relations  with  chloroform,  argued  that  it  should 
possess  anaesthetic  power,  and  proved  that  it  did  so  to  some  extent;  but 
its  local  effect,  when  directly  applied,  is  much  more  marked  than  its 
general  effect  when  taken  or  inhaled.  Twenty  grains  placed  in  the  rec- 
tum are  said  to  destroy  sensibility  in  the  sphincter,  so  that  defecation  is 
not  felt  (More'tin). 

Franchino  corroborated  the  fact  of  local  anaesthetic  action,  and  pro- 
duced some  amount  of  similar  effect  on  the  general  system  in  dogs,  birds, 
and  rabbits,  by  making  them  breathe  2  grammes  of  iodoform  vaporized 
by  means  of  bellows  in  a  closed  chamber:  a  stage  of  excitement  with 
muscular  contraction  was  followed  by  sedation  and  anaesthesia  for  five  or 
ten  minutes;  then  gradual  recovery.  Binz,  however,  could  not  obtain  so 
marked  a  result  as  this,  which  he  attributed  in  part  to  the  carbonic  acid 
confined  in  the  chamber  (Archiv  fur  Exper.  Pathologic:  Klebs,  vol.  viii., 


IODINE.  65 

1877).  McKendrick,  comparing  the  drug  to  chloral,  found  that  10  gr. 
dissolved  in  about  1  dr.  of  alcohol,  and  injected  under  the  skin  of  a  rab- 
bit, produced  profound  sleep  for  four  hours,  and  12  gr.  destroyed  life;  but, 
again,  Binz  failed  to  verify  this  result,  and.  attributed  the  sleep  mainly  to 
the  alcohol.  In  his  own  experiments,  2  grammes  in  oily  solution,  admin- 
istered subcutaneously  to  dogs  and  cats,  produced  but  moderate  sleep  in 
the  course  of  an  hour,  and  3  grammes  impaired  the  functions  of  the  brain 
and  spinal  cord,  without  being  necessarily  fatal.  He  concludes  that 
moderate  doses  exert  some  narcotic  effect,  especially  on  dogs  and  cats, 
but  not  so  much  as  former  observers  thought,  and  that  toxic  doses  kill  by 
general  paresis,  with  lowering  of  temperature  (Edinburgh  Medical  Jour- 
nal, 1874). 

Hogyes,  from  recent  observations  made  in  order  to  reconcile  the  dis- 
crepancies in  the  above  statements,  states  that  large  doses  cause  marked 
drowsiness  in  the  dog  and  cat,  not  in  the  rabbit;  also  that  during  the 
somnolence  reflex  irritability  is  not  much  interfered  with.  Toxic  doses 
cause  death  by  gradual  paresis  of  circulation  and  respiration  (Medical 
Record,  May,  1879). 

Binz  experimented  also  with  the  iodate  of  sodium,  and  found  that  in 
rather  large  doses  this  salt  caused  narcosis  in  animals.  It  proved  es- 
pecially poisonous  to  the  respiratory  and  cardiac  centres,  and  he  suggests 
that  both  this  salt  and  iodoform  are  decomposed  and  liberate  iodine  in 
the  brain  and  cord. 

Digestive  System. — Iodine  has  a  pungent  taste,  and  in  small  doses 
causes  heat  and  stimulation  of  stomach,  with  some  increase  of  appetite. 
A  dose  of  more  than  1  gr.  usually  causes  sickness,  and  5  gr.  give  rise 
to  salivation,  pain  in  the  abdomen,  and  diarrhoea;  large  doses  may  cause 
glossitis,  local  inflammation,  and  ulceration.  Vomiting,  burning  pain, 
spasm,  choking  sensation,  and  impairment  of  the  special  senses,  "were 
symptoms  noted  by  Mr.  Bainbridge  after  the  taking  of  1  oz.  tinct.  iodine, 
British  Pharmacopoeia;  oil  was  given,  and  recovery  occurred  gradually 
(Lancet,  ii.,  1875). 

It  is  remarkable  that  iodoform,  though  containing  so  large  a  percent- 
age of  iodine,  does  not  usually  irritate  the  gastric  mucous  membrane, 
unless  in  toxic  doses.  The  alkaline  iodides  readily  disorder  the  stomach 
in  many  persons,  and  though  at  first  they  may  increase  appetite,  they 
afterward  impair  it.  Small  quantities  are  apt  to  constipate,  but,  if  con- 
tinued they  produce  diarrhoaa,  with  liquid,  slimy  stools.  At  times,  gas- 
tric irritation  and  catarrh  are  the  only  marked  symptoms  of  iodism  (Ril- 
liet).  Leroy  (Brussels)  has  adduced  evidence  to  show  that  when  gastric 
pain  is  caused  by  iodide  of  potassium,  it  is  really  duo  to  adulteration  with 
iodate  ( Medico-  Chirurgical  Jteview,  ii.,  1857).  Mialhe  endorses  this,  and 
Melsens  considers  such  adulteration  dangerous;  five  dogs  were  poisoned 
by  it  ("  Memoire,"  Brussels,  1865). 
VOL.  I.— 5 


66  MATERIA    MEDICA   AND    THERAPEUTICS. 

Rabuteau  points  out  that  either  of  the  salts  separately  is  unacted 
upon  by  weak  hydrochloric  acid,  while  their  mixture  is  quickly  decom- 
posed by  it,  with  liberation  of  free  iodine;  also,  if  fresh  gastric  juice  be 
mixed  with  starch  in  test-tubes  containing  the  one  iodide,  and  the  other 
iodate,  no  blue  reaction  occurs  till  the  contents  of  the  two  tubes  are 
mixed,  implying  that  free  iodine  is  the  irritant  agent  in  the  impure  salt, 
and  that  a  pure  alkaline  iodide  is  non-irritant.  Practically,  however,  I 
am  satisfied  that  as  pure  an  iodide  as  is  obtainable  will  produce  gastric 
irritation  in  some  subjects.  In  the  case  of  all  iodine  compounds,  such 
irritation  may  be  avoided  or  lessened  by  giving  them  freely  diluted,  and 
shortly  after  food. 

Glandular  System. — It  is  commonly  held  that  iodine  stimulates  the 
absorbent  glands  to  increased  action.  This  may  be  an  indirect  effect 
consequent  upon  its  breaking  down  and  rendering  more  susceptible  of 
absorption  certain  kinds  of  tissue.  It  may  be  connected  also  with  its 
quickening  capillary  circulation  in  the  secretory  glands. 

The  salivary  glands  and  the  pancreas,  and  possibly  the  lachrymal 
glands  and  those  of  mucous  membrane  and  the  testes,  have  their  secretion 
increased  by  it.  Rutherford  concluded  that  the  bile  was  not  affected  in 
quantity  (British  Medical  Journal,  1879). 

The  secretion  of  milk  is  usually  lessened  under  the  influence  of  iodides, 
and  may  be  almost  wholly  prevented  by  small  doses  commenced  soon 
after  delivery.  If  already  established,  it  may  be  suppressed  by  the  same 
treatment  if  the  infant  be  not  placed  to  the  breast  (Morris:  JJancet,  ii., 
18Gi).  There  are,  however,  some  observations  to  the  contrary,  e.g.,  those 
of  Lazansky  (Medical  Record,  1878),  who  states  that  iodine  does  not 
affect  the  secretion;  and  certainly  it  may  be  given  to  syphilitic  nursing 
mothers  without  stopping  the  flow  of  milk,  when  this  has  been  established 
for  several  months. 

Whether  iodine  can  cause  atrophy  of  true  glandular  structure  is  an 
important  question  which  is  not  yet  decided  in  the  affirmative,  though 
Rilliet  accepts  its  truth  in  the  case  of  the  testes  and  mammae.  Moisisovitz 
states  that  iodine  has  this  effect,  but  not  the  iodides;  he  refers  to  eight 
hundred  patients  (Canstatt,  1866). 

Certainly  large  quantities  have  been  given  without  any  such  occur- 
rence. Rabuteau  gave  to  a  woman,  in  the  course  of  six  years,  3  kilo- 
grammes of  iodide  of  potassium,  yet  the  breasts  were  not  at  all  affected  by 
it;  and  Velpeau  never  observed  wasting  in  fifteen  thousand  cases  treated 
by  him  (Medico-  Chirurgical  Review,  ii.,  1860).  On  the  other  hand,  one 
case  of  wasting  of  the  testes  is  recorded,  but  is  not  convincing  (Phila- 
delphia Medical  Times,  iv.,  661).  An  enlarged  and  hard  gland  will  grow 
less  under  these  remedies  from  absorption  of  hyperplastic  material,  and 
even  a  healthy  gland  may  grow  smaller  from  absorption  of  fat  or  epithelial 
products;  but,  so  far  as  I  have  seen,  the  breasts,  etc.,  recover  their  natural 


IODINE.  67 

appearance  on  omission  of  the  remedy,  which  they  would  n.ot  do  if  the 
gland-structure  were  actually  destroyed. 

Cutaneous  System. — Various  forms  of  skin-eruption  may  follow  the 
internal  use  of  iodine  or  the  iodides,  the  most  usual  being  allied  to  acne  in 
appearance,  and  (according  to  T.  Fox)  in  pathology  also,  that  is  to  say,  con- 
nected with  irritation  of  the  sebaceous  glands.  Dr.  Thin  denies  this,  and 
connects  iodic  rash  with  alteration  of  the  capillaries,  but  apparently  rests 
his  opinion  upon  a  single  (syphilitic)  case  (British  Medical  Journal,  ii., 
1878). 

Dr.  Duckworth  did  not  find  the  sweat-  or  hair-glands  affected,  and 
speaks  of  the  rash  as  a  "  vesiculating  dermatitis"  (British  Medical  Jour- 
nal,  i.,  1879).  The  pathology  is  probably  not  alike  in  all  cases. 

The  ordinary  rash  is  at  first  papular  and  then  becomes  pustular,  and 
affects  especially  the  face,  head,  and  back;  sometimes  an  erysipelatous 
blush  is  produced,  sometimes  bullge,  ecthyma,  or  anomalous  pustules, 
(Hutchinson),  and  not  uncommonly  petechias,  purpura,  or  hemorrhagic 
effusion  may  be  met  with,  as  already  mentioned.  Much  oedema  of  the 
eyelids  sometimes  occurs.  The  irritant  effect  upon  the  skin  may  be 
much  controlled  by  arsenic. 

Genito-urinary  System. — The  genital  system  is  stimulated  by  iodine, 
sexual  desire  being  increased  under  its  use  (Jorg)  ;  an  increased  flow  of 
blood  to  the  uterus  is  sometimes  determined  by  it.  If  the  iodide  of  potas- 
sium has  a  similar  effect,  it  is  much  less  in  degree. 

The  effect  of  either  preparation  upon  the  urine  is  variable.  Begbie 
speaks  of  iodide  of  potassium  as  one  of  the  best  diuretics  (Lancet,  ii., 
1875),  while  Handfield  Jones,  out  of  six  cases  observed,  found  the  secre- 
tion increased  in  three,  but  diminished  in  two  (Beale's  Archives,  No.  3). 
Rabuteau  observed  no  diuresis  from  15-grain  doses.  Wohler,  giving  iodine 
to  a  dog,  noted  increase  of  urination,  but  only  in  proportion  to  increased 
quantity  of  water  drunk  (Zeitschrift,  1824).  Bassefreund,  from  observa- 
tions on  himself,  concluded  that  the  urine  in  healthy  persons  was  not  aug- 
mented under  iodides;  at  first  it  was  rather  lessened  in  quantity  (Canstatt: 
Jahrb.,  1859).  Very  large  doses  may  irritate  and  congest  the  kidney,  and 
induce  albuminuria,  in  which  case  the  amount  secreted  would  naturally 
be  lessened  (Gubler).  Mr.  Hutchinson  "  suspects  that  iodides  may  cause 
Bright's  disease"  (Lancet,  ii.,  1876).  Dr.  Simon  found  that  albuminuria 
occurred  in  the  majority  of  children  that  had  tincture  of  iodine  externally 
applied,  whether  to  the  scalp,  the  chest,  or  the  knee  (British  Medical 
Journal,  ii.,  1876),  although,  from  the  analyses  of  Dr.  Ord  in  a  case  of 
iodine-poisoning,  the  urinary  precipitate  in  such  cases  would  seem  to  be 
mucin  rather  than  albumen.  As  remarked  by  Mr.  Spencer  Wells,  the  alka- 
line iodides  have  some  power  in  dissolving  uric  acid,  but  this  is  due  proba- 
bly to  the  alkali  rather  than  the  iodine.  H.  Jones  obtained  very  discordant 


68  MATERIA    3IKDICA    AND    THERAPEUTICS. 

results  from  iodide  of  potassium;  in  some  cases  the  uric  acid,  urea,  and 
other  constituents  being  diminished,  in  others  increased. 

In  Dr.  Ord's  case,  urea  and  uric  acid  were  largely  increased.  In  dia- 
betics taking  iodide,  the  same  thing  occurred  (Bouchardat). 

On  the  other  hand,  Rabuteau,  taking  daily,  for  five  days,  15  gr.  of 
iodide  of  potassium,  reported  marked  diminution  in  his  urea-excretion — 
to  the  extent,  some  days,  of  40  per  cent,  during  the  period  of  experi- 
ment, and  for  nearly  a  fortnight  afterward. 

Influence  on  Nutrition. — From  the  above  discrepant  results,  it  becomes 
difficult  to  theorize  concerning  the  action  of  iodine  on  nutrition,  and  fur- 
ther reliable  analyses  of  the  excretion  under  its  use  are  highly  desirable. 
The  French  physiologists  concluded  that  its  influence  resembled  that  of 
arsenic,  i.e.,  was  more  of  alterative,  modifying  character,  than  absorbent 
and  eliminant.  My  own  observations  lead  me  to  place  more  stress  upon 
the  latter.  Although  the  medicinal  use  of  iodides  in  certain  disorders 
may  bring  about  an  improved  state  of  the  nutrition  (Wallace  found,  for 
instance,  that  his  syphilitic  patients  gained  flesh  under  its  use);  yet,  when 
given  continuously  to  persons  of  average  health,  these  medicines  usually 
impair  nutrition  and  induce  more  or  less  emaciation.  This  affects  the 
periglandular  and  fatty  tissues  rather  than  the  true  glandular  structures, 
and  it  may  be  connected  either  with  disturbance  of  digestion,  or  with  cer- 
tain important  physical  effects  recently  traced  to  iodide  of  potassium. 
One  of  these  is  the  increased  rate  of  circulation  produced  in  capillary  tubes 
when  that  salt  is  added  to  the  circulating  fluid  (Poiseuille),  and  the  other 
is  its  dissolving  the  central  substance  of  starch-granules  with  great  expan- 
sion of  peripheral  layers,  so  that  the  grains  become  twenty-five  to  thirty 
times  larger  than  normal  (Payem).  We  may  suppose  that,  introduced  in- 
to the  human  economy,  the  drug  both  quickens  capillary  circulation  and 
dissolves  glycogenic  material. 

PATHOLOGICAL  CHANGES. — After  death  from  iodoform,  fatty  degener- 
ation has  been  found  in  the  liver,  kidneys,  heart,  and  voluntary  muscles. 
Binz  attributes  this  to  the  setting  free  of  iodine  in  the  bodv. 

O  *• 

IDIOSYNCRASY — TOLERATION. — There  is  much  difference  in  the  suscep- 
tibility of  persons  to  the  action  of  iodine,  and  we  can  explain  this  in  no 
better  way  than  as  "  idiosyncrasy."  Speaking  generally,  it  may  be  said 
that  pale,  thin,  languid  patients  often  bear  it  better  than  the  stout  and 
plethoric,  who  have  a  tendency  to  active  head-congestion  or  stasis  of  circu- 
lation. Such  subjects,  if  rheumatic,  are  often  intolerant  of  even  small 
doses;  so  are  the  sufferers  from  goitre  or  exophthalmos,  or  nervous  pal- 
pitation accompanied  with  irregular  flushing  and  impaired  vaso-motor 
power. 

Climate  and  soil  seem  to  have  some  influence,  for  Coindet's  patients  in 
Geneva  were  much  more  susceptible  than  those  of  Ricord  in  Paris\Medico- 
ChirurgicalReview,  ii.,  18GO).  Dr.  Lisson  concluded  that  people  with  fair 


IODINE.  69 

skin  were  more  susceptible  of  the  action  of  this,  and  all  other  drugs  af- 
fecting the  skin,  than  dark  subjects,  and  this  may  prove  some  guide.  He 
himself  was  able,  by  commencing  with  small  doses,  to  induce  a  state  of 
toleration,  so  that  he  could  take  100  gr.  of  iodide  of  potassium  without 
marked  effect  (Lancet,  i.,  1860).  On  the  other  hand,  3-gr.  doses  have 
caused  severe  inflammatory  attacks  (Lancet,  ii.,  1873,  p.  119),  and  even 
a  less  quantity  may  excite  distressing  coryza.  Bad  effects  may,  how- 
ever, be  often  avoided  by  following  Lisson's  plan,  and  inducing  tolerance, 
e.g.,  I  gave  a  patient  with  syphilis  iodide  of  potassium  in  3-gr.  doses 
thrice  daily,  but  he  always  suffered  from  coryza  and  headache  after  two 
or  three  days;  then  it  was  reduced  to  1  gr.,  and  the  same  results  fol- 
lowed; then  he  took  %  gr.  thrice  daily  and  had  no  ill-effects,  and  the 
dose  was  gradually  increased,  and  in  a  few  weeks  he  was  able  to  take  15 
gr.  three  times  daily  without  any  bad  symptoms.  In  one  (exceptional) 
case,  iodism  setting  in  after  the  fourth  dose  of  3  gr.  of  iodide  of  potas- 
sium, affected  the  larynx  so  intensely  as  to  require  tracheotomy  (Lancett 
ii.,  1875);  and,  as  already  mentioned,  Dr.  S.  Mackenzie  traced  fatal  pur- 
pura  in  an  infant  to  2$  gr. ;  but  the  question  may  be  raised  whether  the 
salt  was  quite  pure  in  such  cases.  It  has  also  been  mentioned  that  evil 
results  have  been  attributed  to  an  admixture  with  iodate  of  potash,  and  in 
such  exceptional  cases  an  analysis  should  be  made  with  reference  to  this 
point.  Acute  iodism  is  generally  proportioned  to  the  largeness  of  the 
dose;  but  the  chronic  condition  is  more  readily  induced-  by  continued 
small  doses.  The  iodides  of  sodium  or  ammonium  are  often  (not  always) 
better  borne  than  the  potassium  salt. 

SYNEEGISTS. — The  stimulant  action  of  iodine  is  increased  by  warmth, 
alcohol,  ozonic  ether,  the  essential  oils,  etc.  Ammonia  has  been  espe- 
cially found  to  assist  its  effect  and  enable  it  to  be  borne,  either  by  chemi- 
cal combination  with  it,  or  by  determining  free  circulation  in  the  skin. 

The  absorbent  effect  is  remarkably  aided  by  the  simultaneous  use  of 
mercury,  and  vice  versa  (British  Medical  Journal,  i.,  1875). 

ANTAGONISTS  AND  INCOMPATIBLES. — Cold,  quinine,  digitalis,  the  alka- 
line bromides,  and  other  sedatives  to  the  circulation,  moderate  or  antago- 
nize in  part  the  specific  action  of  iodides;  this  fact,  however,  does  not 
prevent  their  combination  for  therapeutic  purposes.  Starch  and  albumi- 
nous substances  are  the  best  chemical  antidotes  to  iodine  in  cases  of  poi- 
soning. 

Carbolic  acid  and  liquor  ammonije  enter  into  combination  with  the 
drug,  and  remove  its  brown  color,  but  are  said  not  to  lessen  its  active 
properties.  I  have  not,  however,  obtained  as  good  curative  results  in 
absorption  of  tumors  from  the  ammoniated  iodine  as  from  the  pure  drug. 
Bismuth  subnitrate,  which  is  sometimes  prescribed  with  the  iodide  of 
potassium,  precipitates  an  insoluble  red  iodide  of  bismuth.  The  organic 
alkaloids,  strychnia,  atropia,  etc.,  are  precipitated  by  iodine — according 


70  MATERIA    MEDICA    AND    THERAPEUTICS. 

to  Dr.  Fuller,  1£  gr.  of  strychnia  by  1  dr.  of  tincture  of  iodine;  hence,  he 
and  other  observers  have  thought  them  mutually  antidotal,  but  the  com- 
pounds formed  are  themselves  poisonous  (Medical  Times,  i.,  1861;  Lan- 
cet, i.,  1868),  and  require  removal  from  the  stomach  as  much  as  the  original 
poison  {Lancet,  i.,  1876).  The  iodide  of  starch  may  be  antidotal  to  sul- 
phides and  to  caustic  alkalies,  as  stated  by  Bellini. 

THERAPEUTICAL  ACTION  (EXTERNAL). — Iodine  is  used  (both  alone 
and  combined  with  iodide  of  potassium  or  with  camphor)  in  tincture, 
liniment,  and  ointment,  as  a  rnild  stimulant,  or  strong  counter-irritant, 
or  a  caustic,  according  to  the  strength  of  the  application.  It  causes  pain 
when  applied  freely,  and  in  children  and  delicate  tuberculous  subjects 
should  be  used  with  special  caution. 

Strumous  Glands. — "  Iodine  paint  "  is  a  common  and  often  a  useful 
application  to  enlarged  and  hardened  glands  in  the  neck,  groin,  etc.;  but 
sometimes  the  constant  application  of  iodine  lotion  (£  oz.  of  tincture  to 
£  pint  of  water)  gives  a  better  result,  and  is  less  painful.  Mr.  F.  Jordan 
recommends  painting  iodine  not  over,  but  round  the  enlarged  glands,  and 
this  is  sometimes  more  advantageous. 

If  suppuration  has  occurred,  the  tincture  should  be  painted  over  the 
neighboring  thin  skin;  and  if  the  open  sore  remain  indolent,  it  should  be 
dressed  with  iodoforrn  ointment,  or  with  a  solution  of  about  2  dr.  of  tinc- 
ture in  £  pint  of  water,  and  applied  on  lint  covered  with  oiled  silk.  In 
certain  glandular  enlargements,  the  direct  injection  of  iodine  tincture 
acts  better  and  more  quickly.  Bonalimi  (Medical  Record,  1876),  found 
it  more  serviceable  when  the  growth  was  not  scrofulous;  but  Mr.  Brad- 
ley, writing  more  recently,  recorded  a  very  favorable  experience:  1,  in 
true  hypertrophy  of  lymphatic  glands;  2,  in  strumous  hypertrophy,  be- 
fore softening  has  occurred;  3.  in  hard  multiple  lymphomata  and  encap- 
suled  cervical  tumor.  He  used  from  5  to  10  min.  of  tincture,  at  inter- 
vals of  four  to  five  days  (Lancet,  ii.,  1875).  Marston  was  one  of  the  first 
to  use  this  method. 

The  application  of  iodoform  ointment  or  iodoform  collodion  deserves 
trial  before  resorting  to  the  injection.  I  have  seen  some  cases  as  remark- 
able as  the  following,  recorded  by  Dr.  J.  Moleschott.  A  scrofulous  man 
had  a  growth  of  cervical  glands  the  size  of  a  large  fist,  which  was  but  lit- 
tle affected  by  iodide  and  bromide  treatment,  internal  and  external,  and 
continued  for  nearly  three  years.  In  November,  1870,  collodion  15  parts 
and  iodoform  1  part  were  ordered  to  be  applied  night  and  morning;  in 
one  month  the  tumor  was  reduced  one-half;  in  April  it  had  disappeared; 
six  years  after  it  had  not  recurred.  Two  children  with  similar  cervical 
growths,  unaffected  by  ointment  of  iodide  of  potassium,  were  cured  in  a 
few  weeks  by  iodoform;  and  a  woman,  in  whom  the  growth  was  of  "  car- 
tilaginous hardness"  and  as  large  as  a  hen's  egg,  and  of  some  years'  ex- 
istence, obtained  benefit  after  three  months'  use  of  iodoform  ointment  (1 


IODINE.  71 

in  15),  and  cure  within  twelve  months  (Medical  Record,  November  15, 
1878). 

Enlarged  Tonsils. — These  are  often  connected  with  the  strumous  dia- 
thesis, and  iodine  tincture  is  one  of  the  best  local  applications,  though  it 
is  an  unpleasant  one,  and  sometimes  excites  much  irritation.  After  some 
absorption  has  occurred,  I  follow  its  use  with  the  solution  of  perchloride 
of  iron.  In  obstinate  cases  a  few  drops  of  iodine  tincture  have  been  in- 
jected into  the  substance  of  the  tonsil,  with  good  result. 

The  internal  use  of  the  drug,  or  of  iodides  and  cod-liver  oil,  is  desira- 
ble at  the  same  time. 

Bronchocele. — In  cases  of  fibrous  and  fibro-cystic  bronchocele,  where 
calcareous  degeneration  has  not  occurred,  local  applications  of  iodine 
should  be  combined  with  its  internal  use.  If  the  part  be  tender  or  in- 
flamed, soothing  fomentations,  or  even  moderate  leeching,  may  be  needed 
before  using  iodine;  then  either  the  liniment  may  be  painted  on  once  or 
twice  daily  for  several  days,  according  to  the  degree  of  irritation  pro- 
duced, or  an  iodized  collar  may  be  worn  (made  with  iodine  sprinkled  on 
wool),  or  iodoform,  or  iodide  of  mercury  ointment  may  be  rubbed  in  as 
described  (v.  Mercury).  I  have  sometimes  been  disappointed  with  the 
mere  external  use  of  iodine  in  bronchocele,  but  have  had  excellent  results 
from  its  injection  into  fibrous  and  fibro-cystic  cases  (25)  in  which  I  have 
used  it.  In  one  large  fibro-cyst,  as  to  which  there  was  difficulty  of  diag- 
nosis, no  fluid  being  suspected,  30  min.  of  the  tincture  were  injected,  and 
considerable  diminution  of  the  growth  followed;  a  month  afterward  3  oz. 
of  fluid  were  drawn  off,  and  the  cyst  injected  with  2  dr.  of  a  solution 
containing  1  part  of  tincture  to  3  of  water.  The  man  was  highly  scrofu- 
lous, and  the  growth  of  long  duration;  but,  after  the  inflammatory  condi- 
tion set  up  by  the  iodine  had  subsided,  the  bronchocele  disappeared  and 
gave  no  further  trouble.  The  only  case  in  which  dangerous  results  oc- 
curred was  one  in  which  some  iodine  solution  escaped  into  the  cellular 
tissue,  and  sloughing  of  the  part  followed.  Nineteen  out  of  the  25  cases 
got  well,  2  of  them  having  been  injected  seven  times.  Lately,  Dr.  Lticke, 
of  Berne,  has  reported  equally  good  results  in  the  fibrous  form  of  enlarge- 
ment. Of  16  cases  treated  by  him,  11  were  cured  and  4  improved;  and 
Dr.  Morell  Mackenzie,  who  at  first  considered  this  method  inferior  to 
others,  records  his  later  experience  of  it  as  very  favorable.  He  obtained 
unexpected  cures  in  fibrous  and  adenoid  cases  from  the  weekly  or  bi- 
weekly injection  of  30  drops  of  tincture  (Medical  Times,  i.,  1872,  and 
British  Medical  Journal,  ii.,  1873).  Dr.  Luton  speaks  well  of  similar 
injections  of  iodic  acid — 1  part  to  5  of  water;  he  uses  about  ^  dr.  at  one 
time  (Lancet,  ii.,  1873,  p.  457).  (v.  Internal  Use.) 

Orchitis. — If  hardness  and  swelling  of  the  testicle  remain  after  subsi- 
dence of  the  acute  stage  of  this  malady,  iodine  lotion  or  ointment,  with 
strapping,  will  prove  effective.  Alvarez  has  reported  exceptionally  good 


72  MATERIA    MEDICA   AND    THERAPEUTICS. 

results  from  iodoform  ointment  (1  to  2  gr.  to  30  of  simple  ointment)  in 
blennorrhagic  orchitis.  It  is  said  to  relieve  pain  in  one  to  two  hours,  to 
shorten  the  duration  of  the  malady  and  of  subsequent  induration,  and 
"  exert  a  resolvent  action,"  without  any  constitutional  disturbance  like 
that  of  mercury  (Medical  Record,  1877). 

Prostatitis. — In  subacute  and  chronic  enlargement  affecting  the  pros- 
tate gland,  I  have  seen  much  advantage  from  iodine,  and  still  more  from 
iodiform  ointment,  though  Sir  H.  Thompson,  in  his  treatise,  does  not 
speak  favorably  of  the  former,  nor  does  he  mention  the  latter. 

In  cases  of  chronic  enlargement,  Heine  states  that  he  has  injected  the 
tincture  into  the  substance  of  the  gland,  with  successful  results  (Medico- 
Chirurgical  Review,  i.,  1873). 

Mammary  Growths. — Congestions  and  localized  hardness  and  obstruc- 
tion of  mammary  ducts  are  amenable  to  iodine  frictions,  but  the  skin  of 
the  breast  is  very  sensitive  and  easily  irritated.  I  can  recommend  a  weak 
solution  of  iodoform  (1  in  15  to  30)  for  many  of  these  mammary  growths. 
In  1871  I  ordered  it  for  a  lady  with  a  large,  suspicious-looking  tumor, 
which  was  to  have  been  removed  the  following  week  under  the  advice  of 
an  eminent  surgeon.  The  growth  quickly  diminished  under  the  iodoform, 
and  the  lady  is  now  (1880)  quite  well.  This  is  only  one  of  many  similar 
instances  which  have  come  under  my  own  observation. 

Pleuritis — Phthisis. — The  external  use  of  iodine  will  frequently  relieve 
subacute  pleuritic  pain  and  the  "flying"  chest-pains  which  are  common 
in  phthisis.  lodoformed  collodion  (1  part  in  15  to  20)  is  said  to  act  espe- 
cially well  in  such  cases,  and  to  exert  the  further  effect  of  lowering  the 
body-temperature  (British  Medical  Journal,  i.,  1879).  In  chronic  pleuritis 
with  effusion,  iodine  liniment  or  ointment  has  some  power  to  promote 
absorption;  and  in  phthisis  and  chronic  bronchitis,  painting  it  over  the 
front  part  of  the  chest  serves  to  impregnate  the  air  which  is  breathed,  and 
modifies  expectoration  and  the  state  of  the  bronchial  membrane.  Inhala- 
tion of  iodine  may  also  be  practised,  and  a  few  grains  may  be  left  on  a 
plate  in  the  sick-room  with  advantage.  Fetid  organic  odors  from  the 
breath,  etc.,  are  lessened  by  it  (Richardson:  Social  Science  Review,  July, 
1864).  Iodine,  10  gr.,  dissolved  in  1  oz.  amyl  hydride,  makes  a  good  in- 
halation (Medical  Times,  ii.,  1871). 

Diphtheria — Croup. — I  have  found  an  iodized  spray  or  inhalation 
often  useful  in  these  maladies.  Dr.  W.  Curran  gives  a  good  formula, 
containing  4  gr.  each  of  iodine  and  iodide  of  potassium  in  £  oz.  alcohol 
and  4  oz.  water.  Of  this  one  to  four  teaspoonfuls  may  be  added  to  a 
pint  of  boiling  vinegar  or  water,  and  the  vapor  inhaled  every  two  hours 
for  five  to  ten  minutes. 

Menzel  has  injected  a  few  drops  of  tinct.  iodi  into  the  soft  palate  and 
tonsils  in  diphtheria,  and  apparently  with  success  (Medical  Times,  ii., 
1873). 


IODINE.  73 

Chronic  Peritonitis. — In  this  malady,  especially  when  occurring  in 
strumous  subjects,  and  accompanied  with  enlarged  mesenteric  glands,  the 
external  use  of  iodine  in  the  form  of  ointment,  liniment,  or  compress, 
should  be  conjoined  with  internal  treatment. 

Chronic  Visceral  Congestion. — In  chronic  congestion  of  the  liver  and 
spleen,  the  external  application  of  iodine  is  often  useful. 

Uterine  Congestion,  etc. — In  congestive  enlargement  of  the  uterus, 
with  some  induration  of  the  cervix  connected  with  sub-involution  or 
chronic  inflammation,  benefit  may  be  derived  from  iodine  locally  applied. 
Tepid  injections  containing  1  to  2  dr.  of  the  tincture  in  a  pint  of  water,  and 
also  iodized  hip-baths,  are  useful.  Dr.  Greenhalgh  prepares  an  "  iodized 
cotton  "  by  saturating  8  oz.  of  cotton  in  the  same  quantity  of  glycerin, 
containing  1  oz.  of  pure  iodine  and  2  oz.  iodide  of  potassium,  and  keeps 
a  pledget  of  this  pressed  for  some  hours  against  the  cervix,  withdrawing 
it  when  necessary  by  a  thread  secured  to  it.  Dr.  Graily  Hewitt  applies 
the  tincture  directly  to  the  inflamed  part,  and  recommends  this  treatment 
especially  for  patients  of  sluggish  habit  and  scrofulous  diathesis.  My 
own  experience  of  this  treatment  in  similar  cases  is  favorable.  Dr.  James 
Bennett  recommends  direct  injection  of  an  iodized  solution  in  chronic 
cervical  metritis  (Dublin  Medical  Journal,  October,  1878).  In  cases  of 
granular  erosion  and  ulceration,  the  iodide  of  silver,  prepared  extempore 
as  recommended  by  Dr.  Wright,  by  adding  a  few  drops  of  iodine  tincture 
to  some  nitrate  of  silver  solution,  may  be  used  with  much  advantage 
("  Diseases  of  Women  ").  In  amenorrhoaa  dependent  upon  torpor  of  the 
uterine  system,  local  applications  of  iodine  are  useful. 

Menorrhayia. — In  persistent  cases  Dr.  Savage,  and  also  Dr.  Routh, 
have  used  intra-uterine  injections  of  iodine  (Lancet,  1851;  Medical  Times, 
i.,  I860),  but  this  treatment  involves  too  much  risk  for  ordinary  use.  In 
chronic  uterine  leucorrhoea  Dr.  G.  Murray  applies  the  remedy  by  means 
of  a  sound,  which  is  safer  than  injection  (Lancet,  1866). 

Injection  of  Cysts — Hydrocele. — The  injection  of  iodine  in  cases  of 
hydrocele  gives  better  results  than  any  other  remedy.  Port  wine  and 
tincture  of  iron  are  both  very  inferior  to  it.  The  serous  fluid  should  first 
be  evacuated  thoroughly,  and  then  1  to  4  dr.  of  iodine  tincture  injected 
(according  to  the  size  of  the  cyst).  Sometimes  inflammatory  reaction  oc- 
curs, and  lasts  two  to  six  weeks,  but  the  ultimate  result  is  usually  good. 
I  have  seen  one  case  of  fifteen  years'  duration,  where  the  scrotum  hung, 
nearly  to  the  knees,  and  was  supported  by  a  sling  round  the  neck;  after 
puncturing  and  evacuating,  6  oz.  of  iodine  tincture  were  injected:  the 
physiological  effects  were  strongly  developed,  but  complete  cure  fol- 
lowed. 

I  believe  that  Sir  Ranald  Martin  introduced  this  method  of  treatment, 
but  he  diluted  the  tincture  with  two  parts  of  water. 

Mr.  Furneaux  Jordan  has  recently  written  to  advocate  the  use  of  two 


74  MATERIA    MEDICA    AND    THERAPEUTICS. 

or  three  threads  soaked  in  the  tincture  and  drawn  through  the  hydrocele, 
to  act  like  a  seton.  This  succeeds  in  some  cases  (Lancet,  i.,  1876). 

Spina  JBifida. — I  have  not  myself  had  much  experience  recently  in  the 
use  of  iodine  in  this  deformity,  and  what  I  had  in  former  years  was  not 
favorable;  but  the  results  of  Dr.  Brainard,  Dr.  Morton  of  Glasgow,  and 
others,  have  placed  the  operacion  on  a  new  basis.  The  latter  surgeon,  in 
1876,  reported  fourteen  cases,  eleven  of  which  were  successful;  and  in  the 
majority  not  only  was  the  sac  obliterated,  but  improvement  as  to  paraly- 
sis and  general  health  occurred.  The  cases  were  not  simply  those  in 
which  connection  with  the  spinal  canal  was  naturally  obliterated,  and 
which  might  fairly  be  expected  to  recover,  but  included  some  of  much 
more  serious  nature.  The  solution  used  ("  Morton's  solution  ")  was — 
"iodine,  10  gr.,  iodide  of  potassium,  30  gr.,  glycerin,  1  oz.,"  and  of  this  ^ 
to  1  dr.  was  injected  after  removal  of  more  or  less  fluid,  according  to  the 
case  (Lancet,  ii.,  1876). 

Dr.  G.  W.  Thompson  records  an  instructive  illustration,  in  which  the 
tumor  over  the  sacral  region  was  twelve  inches  in  circumference  ten  days 
after  birth;  it  was  attached  by  a  peduncle  and  communicated  with  the 
spinal  canal.  After  tapping  and  removing  about  2  oz.  of  fluid,  25  min. 
of  Morton's  solution  were  injected  and  the  aperture  sealed.  There  was 
much  shock,  and  brandy  was  given  freely.  Gradual  improvement,  how- 
ever, took  place,  and  six  months  afterward  only  a  mass  of  thickened  skin 
remained  (British  Medical  Journal,  ii.,  1878). 

My  colleague,  Mr.  Pearce  Gould,  has  recorded  an  interesting  case  of 
recovery  under  similar  treatment.  The  child,  aged  eighteen  months,  had 
a  sessile  tumor  as  large  as  a  cricket-ball,  situated  over  the  last  lumbar 
and  sacral  vertebrae,  and  communicating  with  the  spinal  canal.  At  the 
first  operation  6  dr.  of  fluid  were  drawn  off,  and  $  dr.  of  Morton's  solution 
injected;  at  the  second  operation  1  oz.  was  removed  and  Idr.  injected;  at 
a  third,  2|  oz.  removed  and  2  dr.  injected.  There  was  neither  shock  nor 
convulsion;  improvement  set  in  on  the  ninth  day  after  the  last  operation, 
and  ultimately  only  a  flat  mass  of  dense  tissue  remained;  there  was  no 
paralysis  ("  Clinical  Society's  Transactions,"  vol.  xi.). 

Of  two  other  cases  treated  by  Mr.  Gould  after  Morton's  method,  one 
died  of  purulent  spinal  meningitis  a  few  days  after  the  second  injection; 
the  other  left  the  hospital  and  was  not  seen  again. 

Hydrarthrosis. — In  extensive  chronic  serous  effusion  in  the  knee- 
joint,  injection  of  iodine  has  been  successfully  practised  by  Velpeau  and 
others.  One  part  of  iodine,  2  of  iodide  of  potassium,  and  8  of  water,  are 
injected  in  about  the  same  quantity  as  is  withdrawn  by  aspiration;  air 
should  be  carefully  excluded  from  the  wound.  Mr.  C.  Macnamara  has  in- 
jected 1  oz.  of  the  pure  tincture  with  quite  satisfactory  result  ("  Lectures 
on  Diseases  of  Bones  and  Joints,"  1881). 

In   less   severe   cases  of   effusion,   in    bursal   effusions    (housemaid's 


IODINE.  75 

knee),  and  in  rheumatic  and  gouty  joints,  the  external  application  of  io- 
doform,  or  iodine  paint,  promotes  absorption,  and  should  be  tried  before 
puncture.  Dr.  Fuller  recommended  a  lotion  containing  £  oz.  of  tinct. 
iod.  co.  in  6  oz.  each  of  glycerin  and  water,  and  applied  on  lint  covered 
with  flannel;  frictions  and  douches  should  be  combined  with  this  treat- 
ment (Lancet,  i.,  1863). 

Pleuritic'Effusion. — The  external  use  of  iodine,  combined  with  pres- 
sure, aids  in  the  absorption  of  such  effusions,  and  some  surgeons  have,  in 
chronic  cases,  injected  a  weak  iodine  solution  (4  to  5  gr.  to  the  pint)  into 
the  pleural  cavity,  and  with  ultimate  success.  It  seems  to  be,  however, 
an  operation  of  unusual  risk,  and  one  which  has  been  followed,  more 
than  once,  by  death  from  inflammatory  reaction,  embolism,  or  shock  (v. 
Empyema). 

In  Ascites  of  chronic  character,  M.  Boinet  injected  iodine,  in  the  first 
instance  by  mistake,  thinking  the  case  ovarian;  but,  after  a  very  serious 
attack  of  peritonitis,  the  patient  at  length  recovered  ("  lodotherapie," 
1855).  Leriche,  Dieulafoy,  and  some  few  other  surgeons  have  recorded 
similar  cases,  and  remark  that  the  ascitic  fluid  should  not  be  all  evacu- 
ated previous  to  injection,  so  that  moderate  dilution  of  the  iodine  may  be 
insured.  Dr.  Ford  (U.  S.),  has  recently  reported  two  cases  of  ascites 
cured  by  iodine  injection,  so  that  the  operation  is  by  no  means  obsolete. 
One  of  his  cases  "  was  connected  with  renal  mischief,"  the  other  "  fol- 
lowed on  cessation  of  the  menses."  After  tapping,  he  injected  2  oz.  of 
tinct.  iodi  with  an  equal  quantity  of  water  (Practitioner,  i.,  1877). 

The  cases  alluded  to  are  not  very  clearly  described  by  their  narrators, 
but  we  must  recognize  that  those  suited  for  this  method  of  treatment 
can  only  be  of  certain  kinds;  for  instance,  such  as  are  dependent  on 
chronic  peritonitis,  or  simple  anomalies  of  secretion,  or  perhaps  on  he- 
patic disorder,  but  not  cases  of  ascites  connected  with  cardiac  or  ad- 
vanced renal  disease,  or  anaemia. 

Empyema. — In  chronic  cases,  provided  a  free  opening  is  secured,  an 
iodine  injection  (1  to  2  dr.  of  tr.  in  the  pint)  is  sometimes  serviceable, 
both  to  disinfect  and  to  stimulate  healthier  secretion  and  contraction  of 
the  cavity,  and  many  patients  have,  doubtless,  recovered  under  its  use. 
Dr.  Dickinson  speaks  of  it  as -better  than  any  other  treatment  in  his  ex- 
perience (British  Medical  Journal,  1876).  On  the  other  hand,  I  have 
myself  known  it  excite  much  undue  irritation,  both  local  and  systemic. 
In  some  cases,  sudden  or  nearly  sudden  death  has  followed  the  injec- 
tion of  iodine  solutions' into  the  pleural  cavity;  but  we  cannot  reasona- 
bly attribute  the  result  to  iodine,  because  in  the  very  same  cases  iodine 
had  been  previously  used  without  harm,  and  besides,  sudden  death  has 
followed,  in  a  similar  manner,  the  injection  of  warm  water,  of  carbolic 
acid  lotion,  etc.  The  effect  may  have  been  connected,  rather,  with  me- 
chanical conditions,  such  as  insufficient  freedom  of  exit,  too  great  pressure 


76  MATERIA    MEDJCA    AND    THERAPEUTICS. 

of  fluid,  etc.,  or  else  with  special  cardiac  conditions  of  feebleness,  dilata- 
tion, etc.,  but  certainly,  I  am  strongly  of  opinion  that  injections  into  the 
pleural  cavity  are  never  without  some  risk,  and  can  seldom  be  practised 
safely;  they  should  be  discontinued  in  favor  of  free  drainage  with  strict 
antiseptic  precautions. 

A  little  of  the  solid  iodine,  placed  in  perforated  chip-boxes  in  or  near 
the  bed,  forms  a  good  disinfectant  in  cases  of  foul  wounds,  discharges, 
etc. 

Pericardial  Effusion. — I  have  treated  several  severe  cases  of  this 
condition  by  iodine  injections;  for  instance:  1.  G.  H.,  aged  thirty-seven, 
had  in  youth  two  attacks  of  rheumatic  fever  with  endocarditis  of  aortic 
valves;  when  otherwise  robust,  a  third  attack  came  on  in  August,  187G. 
In  November,  when  I  first  saw  him,  there  was  extensive  pericardial  effu- 
sion, with  visible  bulging  and  fluctuation;  cardiac  dulness  extended  be- 
yond the  right  of  the  lower  sternum,  and  upward  as  high  as  the  second 
rib;  the  heart-sounds  were  feeble  and  indistinct,  and  the  respiration  im- 
peded; there  was  a  short,  dry  cough,  and  extreme  orthopncea,  so  that 
life  was  in  imminent  danger.  I  drew  out  3  oz.  of  fluid,  and  injected  10 
rain,  of  iodine  tincture;  relief  was  experienced,  and  I  repeated  the  opera- 
tion in  forty -eight  hours.  After  this  the  man  gradually  recovered, 
though  eight  months  afterward  he  died  suddenly  from  his  aortic  disease. 
2.  In  another  man,  aged  twenty-three,  also  suffering  from  extensive  peri- 
cardial effusion,  with  intense  dyspnoea  and  other  urgent  symptoms,  2  to 
3  oz.  of  fluid  were  drawn  off  by  aspiration  (with  much  relief),  and  10  min. 
of  iodine  tincture  injected.  Thirty  hours  afterward,  10  min.  more  were 
injected;  no  symptoms  of  iodism  appeared,  and  the  patient  made  a  good 
recovery.  In  both  cases,  4  to  6  gr.  of  iodide  of  potassium  were  taken  in 
bark  thrice  daily,  before  and  after  the  operation. 

Abdominal  Cysts. — The  following  case,  which  occurred  in  my  prac- 
tice some  years  ago,  will  illustrate  some  of  the  risks  and  the  possibilities 
of  treating  large  cysts  by  strong  iodine  injections.  A  gentleman,  aged 
seventy,  had  an  enlargement  of  the  abdomen,  which  was  obscure  in  its 
nature,  and  variously  diagnosed  as  dependent  on  liquid  effusion  or  a  solid 
growth  from  the  under  surface  of  the  liver.  Attacked  one  day  with 
rigors  and  sudden,  violent  pain,  he  became  jaundiced  and  collapsed,  and 
when  seen  by  me  was  semicomatose  and  apparently  dying.  Some  ob- 
scure fluctuation  being  detected  in  the  enlargement,  a  trocar  was  in- 
serted, and  21  to  23  pints  of  thick,  grumous  fluid,  with  some  pus,  were 
drawn  off;  this  was  examined  by  special  microscopists  without  detection 
of  any  hydatids  or  booklets.  Three  weeks  afterward,  16  pints  of  fluid 
were  drawn  off,  and  16  oz.  of  pure  tincture  of  iodine  (British  Pharmaco- 
poeia) injected,  allowed  to  remain  for  twenty  minutes  in  the  sac,  and  then 
some  of  it  to  escape. 

Severe   effects  soon  followed   the  injection:    salivation,   soreness  of 


IODINE.  77 

mouth  and  throat,  sickness,  eructations,  headache,  giddiness,  tinnitus  au- 
rium,  muscae  volitantes,  etc.,  accompanied  by  palpitation  and  pyrexia; 
the  pulse  was  140,  weak  and  irregular,  the  temperature  101.8°  F.  Epis- 
taxis  occurred  twice  during  the  first  thirty-six  hours;  tightness  across 
the  chest  and  pain  at  the  epigastrium  were  complained  of,  and  frequent 
thin,  watery  stools  were  passed;  the  general  condition  was  one  of  extreme 
nervousness,  prostration,  and  unrest. 

On  the  second  and  third  days  the  temperature,  which  was  highest  in 
the  afternoon,  varied  from  101°  to  104°  F.,  and  the  pulse  from  110  to 
140.  Pains  in  the  limbs  and  in  the  loins  set  in,  and  were  felt  also  in  the 
long  bones,  which  presented  all  the  evidence  of  periostitis;  synovial  effu- 
sion distended  the  left  knee-joint;  the  urine,  which  was  at  first  pale  and 
profuse,  became  scanty  and  bloody,  and  both  it  and  the  saliva  contained 
large  quantities  of  iodine;  the  salivary  glands  were  painful  and  swollen, 
and  the  palate  and  fauces  sore  and  inflamed;  there  was  constant  short, 
dry  cough,  with  more  or  less  aphonia. 

All  these  symptoms  continued  to  increase  until  the  end  of  the  fourth 
day,  when  an  eruption,  somewhat  like  measles,  appeared,  with  apparent 
relief  to  many  of  the  urgent  symptoms.  By  the  fifth  day  the  periostitis 
had  considerably  subsided,  and  by  the  ninth,  most  of  the  other  symptoms 
had  disappeared.  Iodine  was,  however,  excreted  by  the  urine  for  about 
sixteen  days,  and  albumen  for  twenty-five  days;  during  the  whole  time 
nourishment  was  taken  well.  After  the  severe  attack  convalescence  pro- 
gressed favorably,  and  the  patient  lived  for  two  years  afterward,  and  died 
from  the  effects  of  cholesterin  calculus. 

Ovarian  Cysts. — When  the  cyst  is  unilocular  and  no  acute  symptoms 
present  nor  active  growth  going  on,  then  the  injection  of  iodine  may  in 
some  instances  prove  useful,  although  the  radical  operaticm  of  removing1 
the  diseased  ovary  has  now  such  an  average  success  that  the  less  certain 
method  of  injection  is  seldom  employed.  M.  Boinet  records  45  cases, 
treated  by  tapping  and  injecting  equal  parts  of  iodine  tincture  and  water, 
allowing  this  to  remain  for  a  few  minutes  while  the  abdomen  was  gently 
manipulated,  then  to  escape;  31  out  of  these  cases  are  said  to  have  been 
successful,  while  9  ended  fatally.  This  is  a  mnch  higher  mortality  than 
after  ovariotomy. 

Velpeau,  Simpson,  and  Spencer  Wells  have  also  obtained,  on  the 
whole,  favorable  results  with  the  same  method  (Medical  Times,  ii.,  1860), 
but  Dr.  Tyler  Smith  succeeded  in  only  2  out  of  10  cases  in  which  he  em- 
ployed it,  and  of  6  patients  treated  by  Schuh,  only  1  was  cured  and  1  re- 
lieved. My  own  experience  of  injection  in  ovarian  dropsy,  though  not 
large,  is  rather  favorable.  In  one  case,  now  nineteen  years  ago,  I  with- 
drew a  pint  of  fluid  from  a  large  cyst,  and  injected  4  oz.  of  iodine  tinc- 
ture, and  after  repeating  this  three  times,  absorption  ultimately  took  place, 
and  the  lady,  now  living,  has  had  no  further  inconvenience.  In  another 


78  MATERIA    MEDICA    AND    THERAPEUTICS. 

similar  case  in  which  I  drew  off  a  pint  of  fluid,  and  injected  2  to  3  oz.  of 
iodine  tincture,  severe  physiological  effects  followed,  and  continued  for 
ten  days;  but  the  patient  soon  rallied,  and  three  months  afterward  4  oz. 
more  were  injected,  and  absorption  of  the  cystic  fluid  rapidly  took  place. 
This  was  in  1864,  and  at  the  present  time  there  remains  only  a  growth  the 
size  of  an  orange,  which  gives  rise  to  no  annoyance. 

In  both  cases  the  cysts  were  judged  to  be  unilocular,  and  were  of  some 
years'  duration,  but  the  operation,  though  favorable  in  result,  required 
repetition,  and  produced  for  a  time  troublesome  symptoms.  It  is  clearly 
not  one  to  be  adopted  without  much  consideration,  and  only  for  cases 
such  as  those  described,  where  the  patients  would  not  submit  to  removal 
of  the  ovary.  Sometimes  a  fatal  issue  has  followed  directly  from  iodine 
injection,  as  in  the  often-quoted  case  of  Dr.  E.  Rose.  He  injected  into 
an  ovarian  cyst  5  oz.  of  iodine  tincture  containing  1  dr.  of  iodide  of  po- 
tassium, and  severe  symptoms  of  iodism  and  collapse  immediately  set  in, 
with  vomiting  and  cyanosis;  scanty,  dark  urine,  containing  iodine,  was 
excreted;  three  days  afterward  the  cutaneous  capillaries  dilated,  the  face 
flushed,  maculae  appeared  on  the  skin,  and  hemorrhage  occurred  from  the 
lungs  and  uterus. 

On  the  eighth  day,  most  of  the  urgent  symptoms  had  disappeared, 
but  the  urine  still  contained  iodine  and  albumen;  on  the  tenth  day,  death 
occurred  suddenly  from  cardiac  failure  (Nothnagel). 

Manilla. — It  has  been  recommended  to  inject  the  sac  of  a  ranula  with 
iodine  after  emptying  its  contents;  I  have  made  numerous  trials  of  this 
plan,  but  have  abandoned  it  as  unsatisfactory. 

I  used  it  three  times  in  one  case,  but  with  no  other  result  than  to 
cause  much  irritation;  cure  was  ultimately  obtained  by  dilating  the  duct 
aperture  with  laminaria. 

Abscess  Cavities. — The  injection  of  iodine  has  been  resorted  to,  and 
sometimes  with  success,  for  the  purpose  of  disinfecting  such  cavities  and 
controlling  the  secretion  of  pus. 

Boinet  gives  the  history  of  a  chronic  abscess  occupying  the  whole 
right  iliac  fossa;  it  followed  a  bubo,  and  discharged  profusely  by  a  fistu- 
lous  tract.  After  many  months  of  unsuccessful  treatment  by  injections, 
ointments,  nitrate  of  mercury,  potash,  compression,  etc.,  he  injected  a 
solution  of  iodine  (2  dr.  of  tincture  in  4  oz.  of  water)  to  the  bottom  of 
the  cavity  through  a  catheter;  much  pain  followed,  and  afterward  severe 
febrile  reaction,  but  in  about  a  fortnight  radical  cure  was  obtained  (lodo- 
therapie).  Such  successful  results  cannot  be  always  depended  upon,  and, 
in  fact,  I  have  known  injury  from  this  mode  of  treatment  in  many  such 
cases;  for  instance,  in  one  case  of  psoas  abscess,  an  injection  containing  1 
dr.  of  tincture  in  3  oz.  of  water  was  practised  three  times  in  a  fortnight, 
but  considerable  irritation  and  increase  of  hectic  was  set  up  without  sub- 
sequent improvement;  after  an  interval  of  four  months  it  was  repeated 


IODINE.  79 

(1  dr.  in  4  oz.),  but  with  the  same  result,  and  the  patient  died  shortly 
afterward;  vertebral  caries  was  found,  but  only  slight  in  amount. 

In  another  similar  psoas  abscess,  where  the  malady  was  not  recognized 
until  an  opening1  in  the  groin  had  nearly  occurred,  iodine  was  injected, 
and  induced  much  hectic  and  aggravation  of  symptoms;  no  improvement 
could  be  traced  to  repeated  injections,  but  the  patient  is  still  living. 

In  smaller  abscesses  I  have  found  the  injection  of  iodine  beneficial;  it 
offers  less  risk  than  in  large  psoas  abscess,  and  is  more  likely  to  succeed. 
Mr.  Stirton  found  it  answer  well  in  a  chronic  scrofulous  abscess  of  the 
groin — he  used  2  gr.  to  1  oz.  of  water  (Medical  Times,  ii.,  1870). 

Fistula. — In  some  cases,  iodine  injection  is  said  to  have  answered 
well.  Lachrymal  fistula  has  been  cured  by  it  (Lancet,  L,  1874),  also  con- 
genital branchial  fistula  (Medical  Record,  1879).  In  rectal  fistula  an 
ethereal  solution  has  been  of  service  (Lancet,  ii.,  1872),  but  should  not  be 
allowed  to  remain  in  the  bowel,  as  it  may  cause  severe  pain  (Medical 
Times,  \.,  1860).  A  good,  colorless  disinfectant  and  cleansing  lotion  for 
such  cases  is  made  with  tinct.  iodi  3  iss.,  glycerini  §  ij.,  sol.  calcis  chlorin., 
3  vi.;  use  %  oz.  to  6  or  8  oz.  of  water  (Dr.  Boggs).  Mr.  Stirton  has  re- 
lated a  case  of  rectal  fistula  in  which  the  ordinary  operation  had  failed 
several  times,  but  succeeded  when  iodine  injection  was  commenced  im- 
mediately after  it.  In  my  own  experience,  I  have  never  known  iodine  by 
itself  cure  anal  fistula,  and  should  always  recommend  an  operation  in 
preference  to  injections  of  any  kind.  Iodized  injections  are,  however, 
often  useful  in  stimulating  old  atonic  sinuses  in  the  neighborhood  of 
joints,  etc. 

Fissure  of  Anus — Haemorrhoids. — An  ointment  or  suppository  con- 
taining iodoform — 5  to  15  gr.  in  the  ounce — relieves  the  pain  in  defeca- 
tion connected  with  these  maladies. 

Iflceration. — When  the  skin  is  broken  and  there  is  purulent  dis- 
charge, as  in  severe  burns  or  chilblains,  or  after  wounds  or  injuries,  iodo- 
form ointment  or  lotions  of  iodine  will  disinfect  the  pus,  relieve  pain,  and 
promote  healing.  I  agree  with  M.  Lailler  (Hopital  St.  Louis),  who  states 
that  the  former  preparation  acts  as  a  local  anaesthetic,  and  favors  cicatri- 
zation in  a  remarkable  degree,  "  it  modifies  ulcers  of  every  variety,"  but 
should  not  be  used  while  they  are  acutely  inflamed;  this  stage  being 
passed,  the  surface  should  be  carefully  cleansed  and  dried,  and  then  either 
the  finely  powdered  crystals,  or  a  solution  in  sulphuric  ether  (1  part  to  8 
or  10)  should  be  pencilled  over  and  covered  with  lint;  the  ether  evapo- 
rates, leaving  a  thin  film  of  iodoform  (Medical  Record,  February,  1878). 
From  observations  in  eczematous  cases,  Mr.  Squire  concludes  that  it  is 
best  used  during  the  puriform  stage,  and  ceases  to  be  suitable  when  the 
discharge  becomes  purely  serous — he  prefers  a  glycerole  (British  Medical 
Journal,  i.,  1881).  Dr.  Richardson  speaks  highly  of  a  solution  of  iodine 
— 20  gr.  in  amyl  hydride  1  oz. — for  painting  over  suppurating  wounds; 


80  MATERIA    MEDIC  A    AND    THERAPEUTICS. 

this  also  leaves  a  thin  protective  film.  Or  the  vapor  of  iodine  may  be 
applied  by  putting  a  few  grains  of  the  element  between  a  fold  of  lint, 
which  is  placed  over  the  wound  and  covered  with  cerate  and  oiled 
silk. 

In  ulceration  about  the  mouth  and  tonsils,  and  in  the  severe  form 
called  "cancrum  oris,"  touching  with  strong  iodine  solution  is  often  cura- 
tive. 

Onychia. — The  duration  of  this  very  painful  and  obstinate  form  of 
suppuration  may  be  much  shortened  by  iodoform  ointment,  of  strength  1 
dr.  to  1  oz.  (Medical  Times,  ii.,  1872;  Medical  .Record,  1878).  I  have 
used  it  frequently,  with  excellent  results. 

Gingivitis — "  Tartar." — The  local  application  of  tincture  of  iodine 
will  usually  cure  inflammation,  sponginess,  or  tenderness  of  the  gums,  and 
will  soften  deposits  of  "  tartar,"  so  that  they  may  be  readily  removed  with 
the  brush. 

Ulceration  of  Tongue — Gumma. — In  obstinate  syphilitic  affections 
of  this  description,  with  ragged,  thickened  epithelium,  deep  fissures,  and 
severe  pain,  Mr.  Berkeley  Hill  has  found  iodoform  very  useful,  applied 
locally  to  the  part  and  given  internally. 

Syphilitic  Ulceration  of  Throat. — Iodine  liniment  or  iodoform  ex- 
ternally, and  the  tincture  or  iodide  of  potassium  internally,  are  very  ser- 
viceable in  this  condition. 

Chancre — Bubo. — M.  Lailler,  in  a  large  experience  at  the  Hopital 
Lourcine,  found  iodoform  a  most  useful  dressing  for  all  forms  of  venereal 
ulceration  (cf.  Lancet,  ii.,  1878).  Mr.  Berkeley  Hill  adopts  it  as  an  al- 
most invariable  treatment  of  "specific  sores;"  also  Profeta,  Sheen,  and 
others  (Medical  Times,  i.,  1875;  Practitioner,  \.,  1879),  and  Dr.  W.  Cot- 
tie  has  observed  chancres  heal  more  rapidly  under  this  remedy  than  under 
many  others  (British  Medical  Journal,  i.,  1878). 

If  secretion  is  abundant,  the  sore  should  be  cleansed  and  dressed  twice 
daily  with  the  finely  powdered  crystals,  or  an  ointment  containing  iodo- 
form. Smarting  may  be  caused  at  first,  but  this  and  the  pain  of  the 
disorder  soon  subside,  and  healing  often  takes  place  in  a  week  or  ten 
davs.  The  unpleasant  odor  of  iodoform  is,  however,  a  drawback  to  its 
use,  and  its  results  are  not  alwa}rs  so  satisfactory  as  described  above. 

Gonorrhoza. — Gonorrhceal  attacks  in  females  can  sometimes  be  cut 
short  by  one  or  two  paintings  of  the  vagina,  cervix  uteri,  labia,  and 
urethral  canal  with  strong  tincture  of  iodine,  after  first  cleansing  away 
the  discharge.  The  pain  lasts  for  some  hours,  but  the  result  usually  is 
good. 

Purulent  Ophthalmia. — M.  Boinet  relates  a  severe  case  of  double 
ophthalmia  and  scrofulous  catarrh,  which  had  lasted  for  thirteen  months 
when  admitted  into  the  St.  Louis  Hospital,  but  was  relieved;  and,  in  a  few 
weeks,  cured  by  the  constant  employment  of  an  iodine  lotion  and  nasal 


IODINE.  8 1 

injection.     I  began  to  use  this  treatment  in  such  cases  many  years  ago, 
and  often  had  excellent  results. 

Keratitis — Photophobia. — In  ulceration  about  the  cornea,  and  in  gran- 
ular lids,  iodine  tincture  is  a  good  application;  and  the  liniment,  painted 
round  the  eye,  relieves  the  photophobia  so  frequent  in  scrofulous  children. 

Otorrhcea — Aural  Polypus. — Dr.  Cassells  (Glasgow)  states  that  iodo- 
form  is  very  useful  in  these  conditions,  and  in  granulation  from  the 
membrana  tympani,  and  caries  affecting  the  meatus. 

Catarrh. — The  vapor  given  off  by  powdered  camphor  sprinkled  with 
tinct.  iodi  has  been  found  effective  for  arresting  coryza  (Medical  Times, 
i.,  1874);  and  inhaling  from  pure  iodine,  or  carbolate  of  iodine,  is  also 
commended.  The  latter  has  been  introduced  as  a  patent  remedy. 

Ozcena. — In  this  obstinate  disorder,  and  in  various  cases  of  post-nasal 
ulceration  and  discharge,  the  local  use  of  iodoforrn  has  been  much  com- 
mended by  specialists.  Mr.  Woakes,  however,  found  an  ethereal  solution 
very  painful,  and  obtained  good  results  with  pledgets  of  iodoformed  wool 
British  Medical  Journal,  i.,  1878). 

^Erysipelas. — Several  authors  concur  in  stating  that  the  local  use  of 
iodine  tincture  will  relieve  this  inflammation. 

Lanyon  relates  a  case  of  idiopathic  erysipelas,  affecting  the  right  side 
of  the  face  and  rapidly  extending.  The  tincture  was  painted  over  and 
beyond  the  inflamed  part;  within  four  hours  pain  was  relieved  and  sleep 
obtained;  the  malady  did  not  advance,  and,  after  another  application, 
next  day,  convalescence  set  in. 

Boinet  records  two  cases  of  "  traumatic  "  erysipelas — one  connected 
with  suppurating  wounds  in  the  perineum,  and  affecting  the  right  thigh, 
the  other  starting  from  a  varicose  ulcer,  and  affecting  the  whole  leg. 
Thorough  application  of  iodine  tincture,  once  daily  for  three  days,  ren- 
dered the  wounds  healthy,  and  controlled  the  inflammation  and  swelling. 
Dr.  Davies  is  another  advocate  for  the  same  remedy,  used  rather  stronger 
(40  gr.  iodine  to  1  oz.  alcohol). 

Bartholow  and  others  have  not  been  so  well  satisfied  with  it,  and  care 
must  be  taken  not  to  cause  undue  irritation  by  its  use. 

Burns — Chilblains. — In  burns  of  the  first  degree  and  unbroken  chil- 
blains the  pain,  itching,  and  irritation  may  be  relieved  by  iodine  tincture, 
liniment,  or  ointment. 

Lupus. — In  erythematous  lupus,  and  in  early  stages  of  the  tubercular 
and  markedly  strumous  forms,  strong  iodine  paint  is  sometimes  useful; 
equal  parts  of  pure  iodine  and  iodide  of  potassium,  in  two  parts  glycerin, 
may  be  used  about  twice  weekly;  this  excites  "  substitutive  irritation," 
and  exerts  some  absorptive  power,  though  I  have  not  myself  seen  cura- 
tive results  from  it.  The  plain  tincture  of  iodine  relieves  the  congested 
livid  condition  of  the  neighboring  skin  if  painted  over  it.  lodoform  de- 
serves  a  very  careful  trial  (v.  p.  86). 
VoL.  I.— 6 


82  MATERIA    MEDICA    AND    THERAPEUTICS. 

Acne — Sycosis. — Simpson  recommended  for  indolent  "  menstrual  " 
acne,  a  decolorized  iodine  paint  made  by  mixing  tinct.  iodin.  co.  1  part, 
with  liq.  ammonias  2  parts,  to  stand  forty-eight  hours  (Medical  Times, 
i.,  1861).  I  have  not  found  this  preparation  so  effective  as  ordinary 
iodine  when  applied  to  glands,  etc.,  and  for  acne  there  are  several  bet- 
ter remedies.  The  ointment  of  iodide  of  mercury  is  more  valuable 
in  acne  rosacea,  and  that  of  iodide  of  sulphur  in  indolent  acne  and 
sycosis. 

Psoriasis. — In  patches  of  obstinate  chronic  psoriasis  the  ointment  of 
green  iodide  of  mercury,  or  of  iodide  of  sulphur,  is  very  useful.  I  can 
speak  well  especially  of  the  former,  made  in  the  proportion  of  1  part  to 
8  of  simple  ointment.  The  effects  are  often  more  rapid  and  decided  than 
those  of  tar  ointment.  Occasional  alkaline  or  vapor  baths  should  be  used 
during  the  treatment. 

Pityriasis  Capitis — Alopecia. — In  branny,  scaly  conditions  of  the 
hairy  scalp,  and  in  partial  falling  off  of  the  hair  from  debility,  painting 
with  iodine  tincture  acts  as  a  useful  local  stimulant.  It  should  be  com- 
bined with  other  treatment,  such  as  soap-frictions. 

Pruritus. — In  many  varieties  of  this  disorder — pruritus  pudendi,  pru- 
ritus senilis — iodine  tincture  locally  applied  often  gives  much  relief. 

In  a  case  of  hypersesthesia  of  the  vulva,  without  local  lesion,  but  with 
severe  "  dyspareunia,"  powdering  with  iodoform  rendered  the  parts  quite 
insensitive  to  pain  (Tanner).  A  tampon  of  iodoform  had  good  results  in 
another  case. 

Tinea  Tonsurans. — In  simple  recent  cases  of  ringworm  affecting  the 
body  or  the  scalp,  a  few  applications  of  iodine  tincture  or  liniment  may 
suffice  to  cure,  but  they  seldom  succeed  in  an  aggravated  case.  The  prep- 
aration introduced  by  Mr.  Coster  ("  Coster's  paste  ")  is,  however,  more 
powerful.  It  is  a  solution  of  1  part  of  pure  iodine  in  4  of  "  colorless  oil 
of  tar,"  and  requires  to  be  mixed  carefully,  for  heat  is  developed  during 
the  combination;  the  resulting  thick,  dark-colored  liquid  should  be  thor- 
oughly painted  over  the  affected  part  and  allowed  to  form  a  crust,  which 
may  remain  for  seven  to  ten  days.  One  or  two  such  applications  will 
often  cure,  but  to  say  that  they  do  not  cause  pain  is  a  mistake.  The 
pain  has  seemed  to  me  about  equal  to  that  caused  by  the  iodine  liniment, 
which  is  sometimes  severe. 

THERAPEUTICAL  ACTION  (INTERNAL). — Iodine  and  the  iodides  have  a 
similar  action;  the  former  is  more  stimulant  to  the  general  system,  but 
more  irritant  to  the  gastric  mucous  membrane.  It  is  probably  better 
adapted  for  slowly  modifying  the  general  constitutional  state,  as,  for  in- 
stance, in  struma;  while  the  alkaline  iodides,  being  more  quickly  passed 
out  of  the  system,  act  better  where  some  foreign  material  needs  elimina- 
tion, e.g.,  in  syphilis,  lead-poisoning,  or  rheumatism.  Practically,  how- 
ever, the  much  less  irritant  effects  of  the  alkaline  compounds  indicate, 


IODINE.  83 

independently  of  other  considerations,  their  employment  in  the  majority 
of  cases  for  which  iodine  in  any  form  is  needed. 

Metallic  Poisoning. — Melsens  found  that  every  mercurial  compound 
was  soluble  in  an  alkaline  or  neutral  solution  of  iodide  of  potassium,  and 
that  corrosive  sublimate,  for  instance,  if  fixed  in  a  muscle,  tendon,  etc., 
could  be  dissolved  out  of  the  organic  tissue  by  soaking  it  in  such  iodide 
solution.  Also,  that  even  metallic  lead  was,  to  some  extent,  soluble  in 
the  same  medium,  with  formation  of  a  double  iodide  of  lead  and  potassium 
( Medico-  Chirurgical  Mevieic,  i.,  1853).  Hence,  he  argued  that  in  cases 
of  mercurial  or  lead-poisoning,  with  salivation,  tremor,  colic,  palsy,  etc., 
iodides  introduced  into  the  blood  could  form  soluble  compounds  with 
metal  deposited  in  the  tissues,  and  enable  this  to  be  taken  up  by  the  ab- 
sorbents and  passed  out  by  the  kidneys  and  other  channels  of  excretion. 
Support  has  been  given  to  this  argument  by  the  fact  that  an  insoluble 
salt  of  mercury  or  lead  may  be  given  to  animals  without  evident  effect 
until  after  the  administration  of  an  iodide,  when  the  recognized  symptoms 
of  poisoning  appear.  Further,  we  know,  clinicall}',  that  sometimes  in 
metallic  cachexia,  when  active  symptoms  are  no  longer  present,  and  the 
poisons  are  not  detectable  in  the  secretions,  if  an  iodide  be  given,  acute 
mercurial  or  lead-action  may  be  developed,  and  the  foreign  substances 
may  be  found  in  the  urine,  etc. 

Only  chronic  conditions  of  illness,  such  as  palsy  or  cachexia,  may  be 
present  when  the  iodide  is  commenced,  but  in  the  course  of  a  few  days 
acute  symptoms,  such  as  colic  or  salivation,  may  be  reproduced  until  elimi- 
nation is  complete.  But  however  the  theory  on  the  subject  may  stand, 
there  can  be  no  doubt  that  iodides  often  act  well  in  plumbism,  and,  al- 
though I  have  not  always  succeeded  with  them,  I  have  had  some  good 
results.  The  case  of  M.  Faur^  recorded  by  himself,  is  a  good  illustration 
of  their  value:  engaged  in  white-lead  manufacture,  he  suffered  severely 
from  the  ordinary  symptoms  of  plumbism,  and  cured  himself  with  iodide 
of  potassium.  He  remarks  that  he  could  tolerate  the  drug  better  when 
he  took  it  before,  than  with  food,  which  he  attributed  to  the  "fasting 
stomach  being  coated  with  mucus"  (Medical  Record,  187G). 

Dr.  H.  Thompson  has  given  the  details  of  a  case  of  plumbism,  in  which 
iodide  of  potassium,  on  three  or  four  occasions,  led  to  relapse  of  colic  at 
the  same  time  that  iodism  was  developed,  and  these  attacks  were  always 
followed  by  improvement  in  the  paralyzed  extensor  muscles,  as  if  some 
of  the  metallic  poison  had  been  eliminated,  though  there  is  not  a  record 
of  its  detection  in  the  secretions  (British  Medical  Journal,  i.,  1871). 
Jacobs  thinks  the  best  results  are  obtained  with  the  iodide  in  conjunction 
with  emetic  and  purgative  treatment  (Medical  Record,  1877). 

Syphilis. — Tt  is  probable  that  iodine  acts  in  this  disease,  much  as  it 
does  in  metallic  poisoning,  by  assisting  the  elimination  of  a  morbid  ma- 
terial. It  has  been  maintained,  indeed,  by  Dr.  Basham  and  others,  that 


84  MATERIA    MEDICA    AND    THERAPEUTICS. 

its  influence  is  best  seen  in  cases  which  have  been  previously  treated  by 
mercury;  and  Dr.  Budd  and  Dr.  Garrod  have  given  instances  in  which 
mercurial  influence  was  dormant  until  excited  by  the  administration  of 
iodides,  when  profuse  salivation  occurred,  and  recovery  ensued.  But 
there  can  now  be  no  question  that  the  drug  has  curative  powers  of  its 
own,  independent  of  mercurial  action;  they  are  evidenced  especially  in 
the  later,  or  tertiary  stages  of  constitutional  syphilis,  when  either  the 
mucous  membranes  are  affected,  as  in  deep  ulceration  of  the  fauces,  or 
the  bones  are  attacked  with  periostitis  or  nodes,  or  the  skin  suffers  with 
rupial  or  lupoid  eruption,  or  the  brain-membranes  are  thickened,  or  gum- 
matous  deposits  are  formed  in  any  of  the  viscera.  In  such  conditions  it 
usually  acts  far  better  than  mercury,  although  this  latter  drug  is  more 
advisable  in  some  eye-inflammations,  such  as  iritis;  and  again,  in  a  cer- 
tain proportion  of  undefined  syphilitic  cases,  an  iodide  of  mercury  will 
give  better  results  than  either  medicine  alone. 

By  causing  the  absorption  of  deposits  and  thickenings  in  various  parts 
of  the  body,  iodides  cure,  at  the  same  time,  many  secondary  and  depen- 
dent symptoms,  such  as  nocturnal  pains,  neuralgia,  paralysis,  dulness  of 
sense  or  intellect,  and  convulsive  paroxysms.  The  dose  of  iodide  of  pot- 
ash is  a  matter  of  much  importance,  and  need  be  limited  only  by  the  sus- 
ceptibility or  idiosyncrasy  of  the  patient,  and  the  progress  of  the  disease; 
it  may  vary  from  1  or  2  gr.  up  to  60  gr.,  two  or  three  times  daily,  and  the 
best  results  have  sometimes  been  obtained  from  heroic  doses,  when  ordi- 
nary ones  have  failed. 

Elliotson  gave  30  to  60  gr.,  or  more,  for  a  dose  (Lancet,  i.,  1832),  and 
Ricord  commonly  prescribed  the  same  amount.  Sir  A.  Cooper,  Drys- 
dale,  Pollock,  and  others,  have  given  instances  of  the  value  of  such  quan- 
tities (British  Medical  Journal  and  Lance^  1867-68);  and  more  recently 
Dr.  Buzzard  has  pointed  out  the  importance  of  large  doses,  especially  in 
syphilitic  affections  of  the  nervous  system  (Lancet,  i.,  1873). 

In  hereditary  syphilis  I  prefer  mercurial  treatment,  though  infants 
generally  bear  iodides  well. 

Mr.  Berkeley  Hill  has  stated  that  the  iodide  of  ammonium  or  of  sodi- 
um will  sometimes  cure  when  the  potassium  salt  has  failed,  and  this  fact 
should  be  remembered  in  practice  (British  Medical  Journal,  ii.,  1871). 

Rheumatism. — Dr.  Graves  was  one  of  the  first  to  indicate  the  value 
of  iodide  of  potassium  in  rheumatism,  and  it  is  now  well  established.  I 
connect  its  efficient  anti-rheumatic  action  mainly  with  an  eliminant  action 
through  the  kidneys,  and  to  promote  this,  recommend  it  to  be  largely 
diluted  and  combined  with  bicarbonate  of  potash  in  acute  cases.  To  pre- 
vent irritation  of  the  stomach,  the  medicine  may  be  given  in  an  efferves- 
cent form.  Sometimes,  if  the  patient  be  feeble,  and  the  urine  abundant 
and  of  low  specific  gravity,  the  iodide  may  be  combined  with  hydro- 
chloric acid  and  quinine,  as  recommended  by  Dr.  Southey.  When  effusion 


IODINE.  85 

has  occurred  into  the  pericardium  or  the  joints,  tincture  of  iodine  or 
iodides  are  certainly  indicated.  In  muscular  rheumatism  they  are  useful, 
especially  in  those  cases  where  the  pains  are  made  worse  by  warmth.  This 
is  one  character  of  periosteal  and  syphilitic  pain,  and  possibly  some  of  the 
good  results  obtained  from  iodide  of  potassium  in  cases  of  chronic  painful 
joints,  sciatica,  and  lumbago,  may  be  explained  by  its  removing  a  latent 
specific  or  mercurial,  or  other  metallic  taint.  In  cases  of  chronic  rheu- 
matism, small  doses  of  iodide,  continued  for  a  long  time,  often  act  ex- 
ceedingly well;  but  some  patients  are  very  sensitive  to  its  physiological 
action,  and  need  special  care  to  secure  its  toleration  (v.  pp.  68,  94). 

Gout. — In  chronic  forms  of  gout  the  iodide  will  often  relieve,  as 
remarked  by  Mr.  Spencer  Wells,  who  recommends  1  or  2  gr.  thrice  daily, 
well  diluted  with  water  or  seltzer  water.  In  some  cases  the  tincture  acts 
better. 

Chronic  JRheumatic  Arthritis. — In  this  condition,  often  considered 
incurable,  I  have  known  the  tincture  of  iodine  prove  very  useful  when 
given  in  3-min.  doses  thrice  daily,  and  applied  locally;  in  others  the  good 
effect  has  been  remarkable  when  given  at  the  same  intervals,  but  in  doses 
of  10  to  20  min. 

Gouty  Psoriasis. — In  this  malady  the  iodide  deserves  trial.  In  one 
case  of  the  "  inveterate  "  form,  and  of  twenty  years'  duration,  recovery 
followed  the  use  of  10  to  30-gr.  doses.  There  was  no  history  of  syphilis — 
only  some  suspicion  of  it  from  the  copper  color  of  the  rash  (Lancet,  i., 
1871). 

Ague — Tntermittents. — Iodide  of  potassium  is  stated  to  have  proved 
very  efficacious  in  intermittent  fever  (American  Journal,  April,  1867; 
Medical  Times,  ii.,  1872).  The  tincture  of  iodine  is  the  "  Elixir  de  Wil- 
lebrand  "  used  on  the  Continent  in  doses  of  10  to  15  min.,  and,  it  is  said, 
with  success  (British  Medical  Journal,  ii.,  1874). 

Paralysis. — Cases  of  this  disorder  recorded  as  cured  by  the  use  of 
iodides  were  probably  dependent. on  syphilitic  deposits,  or  inflammatory 
or  rheumatic  effusions  pressing  upon  nerve-trunks.  In  such  cases  it  is 
certainly  possible  for  these  remedies  to  produce  the  necessary  absorption 
and  consequent  cure. 

Muscular  Paralysis,  acute  and  general  in  character,  has  sometimes 
yielded  to  the  iodides  in  a  remarkable  manner,  as  instanced  in  a  case  of 
Dr.  Murchison's  (Lancet,  ii.,  1867).  The  man,  aged  twenty-six,  had  grad- 
ual loss  of  power  and  wasting  first  of  the  left,  then  of  the  right  limbs,  and 
then  of  respiratory  muscles,  and  apparently  progressive  paralysis,  with 
moderate  pain,  and  no  cerebral  symptoms;  he  got  worse  under  iron,  ar- 
senic, and  galvanism,  but  improved  markedly  under  iodide.  Another  case 
is  given  in  Medical  Times,  ii.,  1863;  both  were  connected,  probably,  with 
a  spinal  meningitis. 

Cerebral  Palsy  is  not  usually  treated  by  iodides,  but  Dr.  Sieveking 


86  MATEEIA    MEDICA    AND    THERAPEUTICS. 

considers  that  advantage  may  be  derived  from  their  eliminant  action 
after  acute  symptoms  have  subsided  (Medical  Times,  i.,  1857).  They 
may  act  usefully  by  regulating-  and  equalizing  the  circulation,  as  well  as 
by  aiding  absorption  of  any  inflammatory  products. 

Neuralgia. — In  such  cases,  if  of  a  syphilitic  or  rheumatic  origin, 
iodine  is  useful;  and  in  rheumatic  sciatica  the  combination  of  iodide  of 
potash  with  vinum  colchici  is  often  very  effective. 

Chorea. — Manson  affirms  that  he  has  cured  seventy -two  cases  of  chorea 
by  giving  iodide  of  potash.  Bardsley  and  Gibney  make  similar  state- 
ments, but  many  of  these  cases  would  probably  have  come  to  a  natural 
termination  after  six  or  seven  weeks'  rest,  even  without  iodine.  We  arc 
still  much  in  the  dark  as  regards  the  nature  of  chorea,  and  from  a  rational 
point  of  view  iodine  can  only  be  recommended  for  it  as  likely  to  influence 
a  scrofulous,  rheumatic,  or  syphilitic  taint. 

Epilepsy. — Magendie  stated  that  he  had  cured  this  disease  by  iodide 
of  potash,  and  Franklin  gave  to  a  boy,  aged  eight  years,  as  much  as  180 
to  300  drops  of  iodine  tincture,  and  curiously  enough  the  boy  bore  it  well 
and  was  cured  (Kohler). 

It  seems  to  me  that  the  remedy  can  only  serve  in  such  cases  if  there 
be  a  syphilitic  or  rheumatic  origin. 

Struma — Rachitis. — In  the  different  manifestations  of  these  constitu- 
tional states,  such  as  enlarged  glands,  tumid  abdomen,  indolent  ulceration, 
ophthalmia,  etc.,  preparations  of  iodine,  and  especially  the  tincture,  are 
of  proved  value.  But  though  they  lead  to  disintegration  of  morbid  de- 
posit, they  do  not  appear  to  assist  renovation  of  tissue,  and  for  permanent 
good  results  require  to  be  supplemented  by  good  food  and  hygiene. 
Hence,  also,  the  combination  with  iron — iodide  of  iron — is  an  excellent 
form,  and  the  conjoint  use  of  cod-liver  oil  is  very  desirable.  These 
remedies  are  invaluable  in  rachitis  especially,  and  are  usually  well  borne 
by  delicate  children  when  alkaline  iodides  are  not.  Simon,  indeed,  con- 
cludes that  the  latter  ought  not  to  be  given  at  all  under  two  years  of  age 
(Medical  Record,  1876),  and  even  the  iodide  of  iron  sometimes  excites 
gastric  and  renal  irritation,  especially  in  some  delicate  children  with  fair 
skin,  red  hair,  and  enlarged  throat-glands,  so  that  it  is  desirable  to  com- 
mence its  use  in  small  doses. 

I  have  been  accustomed  to  give  1  to  3  min.  doses  of  iodine  tincture 
well  diluted,  and  continued  for  a  considerable  time,  in  cases  of  struma, 
and  can  recommend  this  form  of  medication.  The  iodide  of  ammonium 
is  said  sometimes  to  have  exceptional  value. 

Lupus. — I  have  mentioned  the  external  use  of  iodine  in  the  treatment 
of  this  disease  (v.  p.  81),  and  there  is  some  evidence  in  favor  of  its  in- 
ternal employment.  Thus,  Mr.  Gay  records  cases  of  lupus  affecting  the 
face — in  one  man  for  seven  years,  in  a  woman  for  twenty  years — which 
yet  got  well  under  £-dr.  doses  of  iodide  of  potassium  (Medical  Times,  ii., 


lemons.  87 

1871).  There  was  no  obtainable  history  or  distinct  evidence  of  syphilis, 
though  one  cannot  but  suspect  a  syphilitic  taint  in  such  cases.  I  have 
never  known  iodides  cure  ordinary  lupus,  nor  is  it  a  common  experience. 
Dr.  Mackey  has  noted  two  cases,  in  one  of  which  the  nose  was  affected, 
in  the  other  the  nose  and  scalp;  ulceration  was  deep,  indolent,  and  slowly 
progressive,  in  spite  of  caustic  treatment;  discharge  was  but  slight,  crusts 
formed  at  the  edges,  and  the  cases  resembled  true  lupus,  except  that 
there  were  no  tubercles,  and  the  patients  (men)  were  between  forty  and 
fifty  years  of  age  when  the  sores  commenced.  Both  recovered  quickly 
under  the  influence  of  iodide  of  potassium  and  mercurial  lotions;  but,  al- 
though there  was  no  history  of  syphilis,  the  probability  remains  in  favor 
of  its  existence  in  similar  cases. 

Hydatid  Cysts. — Dr.  Tanner  recorded  a  few  cases  in  which  these 
cysts  wasted  and  were  cured  under  the  internal  use  of  iodide  of  potas- 
sium, and  although  the  relation  of  cause  and  effect  may  be  questioned, 
there  is  some  evidence  of  its  possibility,  and  it  deserves  further  inquiry 
(Medical  Times,  ii.,  1872). 

Meningitis  (?  Tubercular). — I  have  had  several  cases  of  meningitis 
that  derived  benefit  from  iodides,  given  alone  or  in  combination.  In  one, 
a  child,  aged  six  years,  ill  for  eight  days,  insensible,  with  dilated  pupils, 
dysphagia,  paralysis  of  one  side,  and  convulsive  twitching,  getting  worse 
under  previous  treatment,  improvement  began  soon  after  commencing 
iodide  of  potassium,  which  was  given  in  5  to  10-gr.  doses  every  four  hours, 
and  5  min.  of  tincture  of  belladonna  midway  between.  Recovery  ulti- 
mately ensued,  and  the  boy  is  now  sixteen  years  of  age.  In  another  case 
of  mine,  aged  eight  years,  the  child  had  pain,  vomiting,  delirium,  uncon- 
sciousness, convulsion,  dilated  pupils,  tetanic  stiffness  of  the  neck-muscles, 
grinding  of  teeth,  difficult  respiration,  slow,  weak  pulse,  and  every  sign 
of  fully  developed  meningitis,  yet  recovered  under  iodide  of  potassium 
and  belladonna,  with  occasional  doses  of  aconite.  Dr.  Leared  recorded 
a  case  of  recovery  under  5-gr.  doses  of  iodide  of  potassium  when  other 
remedies  had  been  .used  without  relief.  He  was  satisfied  as  to  the  diag- 
nosis of  "  tubercular  meningitis."  M.  Rodet  has  recently  recorded  a 
severe  case  in  a  girl  of  eighteen  recovering  under  daily  doses  of  4  to  5 
grammes,  and  considers  failure  due  to  insufficient  dosage  (Medical  Rec- 
ord, May,  1879).  Other  desperate,  but  successful  cases  are  on  record 
(Edinburgh  Medical  Journal,  1841;  London  Medical  Gazette,  1842; 
Medical  Times,  i.,  1859;  Bulletin  de  Therapeutique,  August,  1861,  etc.); 
and  M.  Golfin  (Montpellier)  narrates  three  cases  of  this  malady  which  re- 
covered from  the  second  or  third  stage  under  frictions  with  an  iodide  of 
mercury  ointment  to  the  scalp.  (Hydrarg.  iodid.  virid.,  gr.  ij. ;  Potas. 
iod.,  gr.  iij. ;  Camphorse,  gr.  ij.;  Cerat.  Galeni,  gr.  xxxij.) 

In  one  child,  aged  four  and  a  half  years,  the  symptoms  showed  death  to 
be  imminent:  the  head  was  drawn  back,  the  face  pale,  pupils  dilated  and 


88  MATERIA    MEDICA   AND    THEE  APE  DTICS. 

immovable,  swallowing  power  was  lost;  partial  paralysis,  convulsion,  and 
profound  coma  were  present;  the  pulse  was  scarcely  perceptible.  About 
forty  hours  after  commencing  the  iodo-mercuric  frictions,  urine  flowed, 
and  the  paralysis  and  convulsion  gradually  lessened;  in  the  course  of  four 
days  only  headache  and  stupor  remained,  and  by  the  fifteenth  day  con- 
valescence had  set  in  (Gazette  Medicate  de  Montpellier,  February,  1847). 
Niemeyer  speaks  favorably  of  iodic  frictions  in  basilar  meningitis.  The 
degree  of  credence,  however,  to  be  given  to  such  remarkable  cases  as  the 
above  must  depend  upon  the  accuracy  of  the  diagnosis,  for  brain-conges- 
tion or  brain-ansemia  in  children,  and,  still  more  closely,  simple  meningitis, 
may  simulate  acute  hydrocephalus  to  some  extent,  and  I  have  certainly 
seen  improvement  under  local  frictions  with  iodized  ointment,  and  inter- 
nal treatment  by  iodide,  bromide,  and  belladonna. 

Trousseau  and  many  physicians  of  experience  deny  that  the  tubercular 
form  is  curable  under  any  circumstances,  and  certainly  a  large  majority 
of  such  cases  end  fatally.  Dr.  Wilks  "  has  seldom  seen  any  good  results  " 
(Medical  Times,  ii.,  18G8). 

In  one  case  of  hydrocephalus  Brainard  practised  injection  of  iodine 
into  the  ventricles  many  times,  with  temporary  improvement,  but  the  child 
ultimately  died  in  convulsions. 

Phthisis. — Chronic  congestive  conditions  of  lung  following  on  acute 
inflammations  are  usually  connected  with  the  scrofulous  diathesis — pneu- 
monic phthisis  especially.  In  such  cases,  benefit  may  be  obtained  from 
iodine  preparations.  I  prefer  the  tincture;  but  the  iodide  of  iron,  or  the 
iodide  of  ammonium,  is  useful,  according  to  the  case. 

In  the  more  acute  form  of  tubercular  phthisis,  when  the  patient  suf- 
fers from  loss  of  flesh,  quick  pulse,  high  temperature,  pain,  cough,  dysp- 
noaa,  and  nocturnal  sweatings,  the  tincture,  given  every  four  hours,  and 
inhaled,  as  well  as  applied  locally  over  the  chest,  offers  a  chance  of  arrest- 
ing or  ameliorating  the  disease..  In  some  cases  under  my  care,  this  treat- 
ment appeared  to  check  the  disease. 

In  tubercular  phthisis,  in  the  absence  of  acute  symptoms,  I  have  seen 
benefit  from  iodine  and  iodides,  but  have  sometimes  noticed  haemoptysis 
following  their  use,  and  therefore  recommend  caution  in  cases  disposed 
to  hemorrhage. 

Earlier  observers — Chevallier,  Elliotson,  Bardsley,  and  others — thought 
iodine  really  curative  in  consumption.  It  can  certainly  lessen  pulmonary 
induration  and  modify  the  irritative  conditions  of  the  bronchial  mucous 
membrane  and  the  character  of  expectoration;  in  fact,  I  have  seen  most 
symptoms  improve  under  its  use,  but  this  must  be  supplemented  by  hy- 
giene and  generous  living.  Dr.  Cotton's  experience  at  Brompton  Hospital 
was  not  so  favorable:  weight  was  seldom  gained  under  iodide  of  potas- 
sium— generally  diminished;  dyspepsia  was  sometimes  induced;  usually, 
no  definite  effect  could  be  traced  (Medical  Times,  ii.,  1859).  Dr.  Julius 


IODINE.  89 

Pollock,  on  the  other  hand,  found  the  remedy  very  serviceable,  and  his 
patients  gained  weight  under  its  use. 

I  have  noted  most  benefit  in  cases  of  chronic  phthisis,  and  especially 
when  a  syphilitic  taint  existed.  Dr.  B.  W.  Foster  suggests  that  it  acts 
by  stimulation  of  the  pancreas,  thus  promoting  assimilation  of  fatty  food, 
and  Claude  Bernard  proved  its  elimination  by  that  gland.  Iodine  inhala- 
tions in  phthisis  have  proved  of  great  value  in  my  experience,  exerting 
a  disinfectant,  and  to  some  extent  a  resolvent  action.  It  is  important 
to  guard  against  soreness  of  mouth  and  undue  irritation  of  the  air-pas- 
sages during  their  use. 

Bronchitis. — In  the  subacute  and  chronic  stages,  iodide  of  potassium, 
or  of  ammonium,  relieves  by  an  alterative  action  on  the  bronchial  mucous 
membrane,  thinning  and  ultimately  diminishing  the  semi-purulent  tough 
secretion.  They  may,  sometimes  with  advantage,  be  combined  with  anti- 
spasmodics  and  other  expectorants.  In  weakly  subjects,  the  iodide  of 
ammonium,  in  doses  of  from  2  to  5  gr.  every  four  hours,  may  act  better 
than  the  potassium  salt.  When  there  is  an  increase  of  temperature, 
aconite  also  should  be  given  in  doses  of  from  1  to  3  or  5  min.  every  two 
to  four  hours.  If  an  expectorant  is  required,  tartar  emetic  should  be 
chosen.  The  dose  should  be  small  and  frequent,  and  care  should  be 
taken  to  avoid  emesis.  With  ordinary  precaution  in  the  regulation  of 
the  dose,  neither  aconite  nor  antimony  need  be  dreaded  for  their  depress- 
ing action,  and  it  is  remarkable  how  favorably  these  medicines  act  in 
conjunction  with  iodides. 

Asthma. — I  have  known  iodide  of  potassium  relieve  many  asthmatic 
patients,  and  Horace  Green  (1860)  found  it  to  be  the  main  ingredient  in  a 
secret  and  successful  remedy  for  asthma.  Trousseau  and  Jaccoud  speak 
of  its  value,  and  M.  See  records  valuable  observations  upon  twenty-four 
cases  watched  for  a  long  time.  Four  of  these  were  children,  four  old  peo- 
ple, the  others  adults;  the  daily  dose  varied  from  22  to  45  gr.,  it  being  re- 
duced as  improvement  progressed;  if  given  some  hours  before  the  usual 
attack,  this  was  often  prevented;  if  given  during  it,  respiration  was  ren- 
dered free  in  one  to  two  hours.  Chronic  asthma  with  emphysema  was 
also  benefited  by  the  remedy;  inhalations  of  the  iodide  of  ethyl,  six  to 
ten  drops  several  times  daily,  and  the  occasional  use  of  opium  or  chloral 
in  these  latter  cases,  were  with  advantage  conjoined  with  the  treatment 
(Medical  Record,  1878).  Dr.  Hyde  Salter  has  observed  benefit  from 
iodide  of  potassium  in  full  doses — 15  to  30  gr. — every  two  to  four  hours, 
in  very  diverse  cases  of  asthma.  I  think  that  such  attacks  as  are  con- 
nected with  catarrh  and  are  relieved  by  free  secretion,  and  in  which  the 
nerve-symptoms  are  reflex,  rather  than  primary,  show  the  best  results 
from  this  remedy.  I  have  known  it  efficacious  in  asthma  connected  with 
amenorrhoea  and  uterine  congestion,  and  also  in  the  asthma  of  rheumatic 
and  gouty  subjects.  In  an  interesting  case  in  a  very  rheumatic  patient, 


90  MATERIA    MEDICA    AND    THERAPEUTICS. 

the  asthmatic  attack  was  relieved  by  4-gr.  doses  of  iodide;  but  severe 
pain  in  the  region  of  the  kidney  followed,  with  secretion  of  scanty,  acid 
urine;  this  occurred  more  than  once,  and  was  only  relieved  by  free  ex- 
cretion of  alkaline  urine  under  appropriate  remedies  (British  Medical 
Journal,  January,  1875).  In  this  case  the  drug  was  supposed  to  cause 
renal  congestion  by  increasing  the  absorption  of  waste  nitrogenous  mate- 
rial, and  consequently  the  amount  to  be  eliminated.  I  have  known'iodine 
itself  produce  renal  congestion  in  some  individuals. 

Dr.  C.  J.  B.  Williams  has  seen  a  very  large  number  of  asthmatic 
cases  relieved  by  iodide  and  by  carbonate  of  potash  with  stramonium 
(Medical  Times,  i.,  1872),  but  most  of  M.  See's  cases  were  relieved  by 
the  iodide  alone.  Dr.  Reed  recommends  the  liquor  iodinii  in  "  dry 
asthma  "  of  constitutional  character  and  without  obvious  exciting  cause 
(Medical  Record,  1879). 

I  believe  that  the  drug  acts  directly  on  the  mucous  membrane,  reliev- 
ing its  congested  state  by  promoting  a  thin,  fluid  secretion;  but,  inde- 
pendently of  any  theory,  it  will  be  found  worthy  of  trial  in  any  rebel- 
lious case. 

Catarrh. — Iodide  of  ammonium,  in  1-gr.  doses  every  two  to  four 
hours,  is  a  good  remedy  in  ordinary  acute  catarrh. 

Hay- Asthma.  —  In  this  distressing  malady,  iodide  of  ammonium, 
combined  with  arsenic,  will  often  give  a  better  result  than  either  rem- 
edy alone.  Weak  iodine  solution  should  be  injected  into  the  nares,  or, 
what  is  more  convenient,  the  vapor  of  iodine,  or  of  carbolate  of  iodine, 
should  be  inhaled  by  the  nostrils,  as  recommended  by  Melville  (Lancet, 
ii.,  1864). 

Sore-Throat. — In  cases  of  follicular  tonsillitis,  or  when  spots  of  ulcera- 
tion  about  the  buccal  mucous  membrane  are  induced  by  cold,  small  doses 
of  iodide  are  useful. 

Croup — Diphtheria. — The  tincture  of  iodine,  as  well  as  the  iodides, 
are  very  valuable  in  these  disorders,  especially  in  their  early  stages;  they 
should  always  be  given  in  conjunction  with  aconite,  and  occasionally  the 
judicious  use  of  an  emetic  is  serviceable.  I  trace  the  benefit  following 
the  use  of  the  iodide  partly  to  a  local  effect,  rendering  the  false  mem- 
brane less  tenacious,  and  partly  to  an  eliminant  action  on  the  kidne3rs. 
Its  use  by  inhalation  has  already  been  mentioned,  and  should  be  strictly 
attended  to  (v.  p.  72). 

Albuminuria. — The  prolonged  administration  of  iodide  of  potassium 
in  chronic  Bright's  disease  is  said  to  have  retarded  fibroid  changes  in  the 
kidney,  and  induced  general  improvement  in  nutrition  (Bartholow).  Dr. 
Crequi  (Brussels)  recommends  it  for  the  second  or  parenchymatous  stage. 
Using  commonly  G  gr.  or  more  daily,  he  has  sometimes  given  as  much  as 
6  dr.  in  the  day,  with  bismuth  or  opium  to  control  irritative  effects.  He 
presumes  the  iodide  acts  by  limiting  morbid  secretion  in  the  renal  tubules 


IODINE.  91 

(Lancet,  i.,  1871).  In  subacute  cases,  with  dropsy,  I  have  frequently 
used  this  remedy  in  doses  of  3  to  4  gr.,  and  have  seen  apparent  advan- 
tage from  it.  I  think  it  hastens  absorption  of  inflammatory  products,  but, 
from  what  has  been  already  stated  as  to  the  possibility  of  its  causing  re- 
nal congestion  (v.  p.  67),  it  must  be  considered  unsuitable  in  acute  neph- 
ritis, unless  in  fractional  doses. 

Ascites — Anasarca. — Not  only  in  renal  dropsy,  but  in  that  dependent 
on  hepatic  disease,  and  certainly  in  general  anasarca  independent  of  or- 
ganic malady,  iodide  of  potassium  or  iodide  of  iron  is  useful.  Frictions 
with  iodized  liniment  should  be  combined  with  the  internal  treatment. 
Injections  have  sometimes  been  used  (v.  p.  75). 

Aneurism. — In  those  cases  of  thoracic  and  abdominal  aneurism,  in 
which  surgical  treatment  is  impossible  or  highly  dangerous,  the  clinical 
results  obtained  by  iodide  of  potassium  should  not  be  ignored.  Nelaton 
recorded  marked  relief  to  the  signs  and  symptoms  of  an  innominate  aneu- 
rism under  the  use  of  this  remedy,  which  he  gave  empirically  at  the  re- 
quest of  the  patient;  and  Bouillaud,  following  up  this  clue,  obtained  good 
results  in  aneurisms  of  the  carotid  and  thoracic  vessels  (Medical  Times,  i., 
1859). 

Chuckerbutty,  in  Calcutta,  published  three  cases  relieved,  in  one  of 
which  the  aneurism  was  already  projecting  through  the  sternum  when 
the  drug  was  commenced,  and  Dr.  W.  Roberts  and  Mr.  Windsor  recorded 
some  equally  striking  results  about  the  same  time  (British  Medical  Jour- 
nal, ii.,  1862;  i.,  1863). 

It  is,  however,  to  Dr.  Balfour  that  we  are  most  indebted  for  drawing 
professional  attention  to  this  subject  (Edinburgh  Medical  Journal,  1868- 
1869).  He  summarizes  15  cases,  all  of  which,  save  one,  were  relieved,  and 
in  12  the  external  tumor  was  actually  lessened  and  the  sac  partly  consoli- 
dated. In  one  of  his  earliest  patients  the  bulging,  which  was  evident 
between  the  second  and  third  ribs,  disappeared  after  a  few  weeks'  treat- 
ment with  30-gr.  doses  thrice  daily,  and  this  dose  was  continued  for  nine 
months  "  without  any  unpleasant  symptoms,"  but  with  complete  subsid- 
ence of  aneurismal  suffering.  The  same  man  had  not  improved  under 
previous  doses  of  20  gr.,  and  Dr.  Balfour  points  out  the  importance  of 
pressing  the  drug  to  saturation  before  considering  it  inert.  It  is  very 
quickly  eliminated — large  doses  within  two  or  three  days — and  many  of 
his  patients  took  20  to  30  gr.  several  times  daily.  In  a  few,  coryza  and 
headache  were  quickly  induced,  and  5  gr.  only  were  tolerated,  but,  as  a 
rule,  no  worse  symptoms  were  caused  by  large  than  by  small  doses.  Ad- 
ditional evidence  in  favor  of  this  treatment  has  been  furnished  by  Dr. 
W.  Roberts,  Dr.  Shapter,  and  others  (Medical  Times,  1874;  British 
Medical  Journal,  1873-74),  and  recently  Dr.  Philipson  has  reported  a 
cure  of  an  abdominal  aneurism  (British  Medical  Journal,  i.,  1878). 

It  seems  to  me  no  argument  against  such  cases  to  say,  with  Dr.  Bris- 


92  MATERIA   MEDICA   AND    THERAPEUTICS. 

towe,  that  any  remedy  which  coagulates  the  blood  in  an  aneurismal  sac 
must  tend  to  coagulate  it  elsewhere,  and  is  therefore  inadmissible;  or  to 
note  with  Mr.  Holmes  that  aneurism  may  sometimes  develop  in  patients 
already  under  the  influence  of  iodide  (Medical  Times,  i.,  1872).  This  is 
only  saying  that  the  remedy  is  not  infallible,  and  that  its  mode  of  action, 
whether  on  the  composition  or  vital  condition  of  the  blood  (Chuckerbutty, 
Roberts),  on  the  nervous  system  (Balfour),  or  on  the  walls  of  the  sac,  is 
not  yet  clear.  I  have  myself  seen  remarkable  advantage  from  its  use, 
arid  suggest,  in  addition  to  the  above  explanations,  a  possible  anti-syphi- 
litic effect — for  the  occasional  connection  of  syphilis  and  aneurism  is  suf- 
ficiently proved  by  modern  research. 

Chronic  Inflammatory  Indurations. — In  simple  chronic  enlargement 
of  glandular  organs,  the  liver,  the  spleen,  the  mammary  gland,  or  the 
testes,  iodine  is  often  of  more  service  than  any  other  medicine.  The 
cause  may  be  syphilis,  struma,  or  malaria,  and  yet  the  same  remedy  be 
applicable. 

I  generally  recommend  1  to  5  min.  of  tincture  thrice  daily  for  a  long 
period,  though  sometimes  iodides  are  better  borne.  External  painting, 
or  iodine  compresses,  should  be  used  at  the  same  time.  lodoform  oint- 
ment, or  iodoform  collodion,  is  also  to  be  highly  recommended  (v.  pp.  70, 
73). 

J3ronchocele. — In  simple  soft  goitre,  in  which  malady,  indeed,  the 
reputation  of  iodine  was  first  acquired,  I  consider  it  almost  a  specific.  In 
recent  cases,  1  to  5  min.  doses  of  the  tincture  produce  the  best  results, 
for,  if  unduly  large  quantities  be  given,  the  swelling  becomes  hard,  ten- 
der, and  painful.  In  more  chronic  cases  already  indurated,  large  doses — 
£  to  1  gr.  of  iodine — may  be  given  in  conjunction  with  its  external  use 
(v,  p.  71);  some  astringent  syrup,  e.g.,  of  cinchona  or  orange-peel, 
should  be  added  to  prevent  derangement  of  stomach.  Mr.  Bryant  has 
known  goitres  rapidly  disappear  under  the  influence  of  an  iodized  atmos- 
phere, obtained  by  simply  placing  iodine  in  a  perforated  box  in  the 
patient's  room;  he  recommends  also  the  local  use  of  an  ointment  of  iodide 
of  ammonium  ("  Practical  Surgery,"  3d  Ed.). 

In  Exophthalmic  Goitre  I  have  also  seen  a  limited  amount  of  success 
from  the  internal  use  of  iodine  tincture,  the  palpitation  being  frequently 
relieved  by  small  doses. 

Uterine  Fibroma. — Fibroid  growths  or  indurations,  especially  those 
originating  in  the  cervix,  i.e.,  in  the  more  glandular  and  secretory  part  of 
the  uterus,  often  improve  under  the  use  of  iodine  or  iodides.  Dr.  Ash- 
well  long  since  described  them  as  "  melting  down"  under  this  treatment 
(Guy's  "Reports,"  vol.  i.),  and  mineral  waters,  of  deserved  repute  in  such 
cases,  owe  their  efficacy  to  a  combination  of  iodides  and  bromides  (v.  p. 
118). 

Direct  injection  of  the  drug  into  the  growth  is  also  a  valuable  resource 


IODINE.  93 

with  due  precaution.  I  have  injected  10  to  20  min.  of  an  aqueous 
solution  of  iodine  (half  the  strength  of  the  British  Pharmacopoeia  tinc- 
ture) in  twenty-three  cases  of  uterine  fibroids  of  large  size,  and  repeated 
the  operation  several  times  with  encouraging  results.  Nearly  all  im- 
proved considerably  under  the  treatment,  and  the  tumors  disappeared,  in 
five  instances,  within  twelve  months  of  the  first  injection.  Two  cases 
suffered  considerably  from  local  inflammation,  obliging  the  treatment  to 
be  discontinued  after  the  third  and  fourth  injections  respectively;  but 
both  these  cases  eventually  improved  more  quickly  than  any  of  the  others. 

In  Passive  Uterine  Congestion  tincture  of  iodine  is  often  useful;  and 
Dr.  J.  B.  Schmidt  has  written  to  recommend  minim  doses  for  chlorotic 
subjects  suffering  from  headaches,  frequent  menstruation,  and  diarrhoea 
("  Medico-Chirurgical  Transactions,"  L,  1871). 

Amenorrhoea — Sterility. — When  these  conditions  depend  on  func- 
tional causes,  congestion,  torpor,  debility,  etc.,  iodine  and  the  iodides  are 
useful.  I  have  often  proved  them  so  in  the  former  condition,  and  some- 
times in  sterility  they  exert  a  stimulating  effect  on  the  uterus,  possibly 
because  of  their  elimination  by  the  mucous  membrane. 

Vomiting  of  Pregnancy,  etc. — I  have  known  1  to  5  min.  doses  of  the 
tincture  arrest  the  capricious  vomiting,  also  the  pyrosis  and  heartburn  of 
pregnancy,  possibly  by  a  stimulant  effect  on  the  gastric  membrane.  Its 
local  application  to  the  cervix,  conjoined  with  its  internal  administration, 
often  acts  with  advantage.  Dr.  Eulenburg  recommends  10-min.  doses  as 
very  serviceable,  but  I  prefer  the  smaller  doses  repeated  every  two  or 
three  hours. 

Atonic  Diarrhoea,  Dysenteric  Diarrhoea,  etc. — I  have  obtained  benefit 
from  similar  doses  in  atonic  diarrhosa,  and  in  the  form  which  occurs  dur- 
ing phthisis.  They  have  been  recommended  in  cases  of  passive  hemor- 
rhage and  serous  intestinal  flow  dependent  on  "  paralysis  of  the  gangli- 
onic  centres"  (Schmidt:  Medico-Chirurgical  JReview,  i.,  1871);  also  in 
later  stages  of  typhoid  fever.  Iodized  enemata  have  been  used  in  dysen- 
tery to  relieve  tenesmus  (Medical  Times,  i.,  1857) ;  1  to  5  min.  doses  of 
the  tincture,  given  every  four  hours  with  cinchona,  will  cure  the  tormina 
and  the  tenesmus  of  dysenteric  diarrhoea. 

PREPARATIONS  AND  DOSE. — Tinctura  iodi  contains  iodine,  £  oz.,  iodide 
of  potassium  £  oz.,  rectified  spirits  20  fluid  oz. :  dose,  5  to  20  min.  Liquor 
iodi  contains  20  gr.  iodine,  30  gr.  iodide  of  potassium,  in  1  oz.  water: 
dose,  3  to  10  min.  Linimentum  iodi  contains  iodine  1£  oz.,  iodide  of 
potassium  •£  oz.,  camphor  £  oz.,. rectified  spirit  10  oz.  Unguentum  iodi: 
iodine  32  gr.,  iodide  of  potassium  32  gr.,  proof  spirit  1  dr.,  prepared  lard 
2  oz.  Vapor  iodi  (inhalation  of  iodine)  contains  tincture  of  iodine  1  dr., 
water  1  oz.;  heat  slightly  for  inhalation  of  vapor.  lodoformum:  dose,  4- 
to  2  gr.  in  pill,  or  pastilles — as  made  by  Messrs.  Bullock,  containing  2  gr. 
in  each  (Medical  Times,  ii.,  1878).  Unguentum  iodoformi :  1  part  in  8. 


94  MATERIA   MEDICA    AND    THERAPEUTICS. 

Collodium  iodoformi:  1  part  in  16.  A  suppository  containing  20  gr. 
with  cacao  butter  is  officinal  in  the  German  Pharmacopoeia.  Potassii 
iodidum,  sodii  iodidum:  dose,  from  \  to  30  gr.  and  upward  in  syphilis; 
average  dose,  3  to  5  gr.  The  dose  of  the  ammonium,  salt  is  somewhat 
smaller. 

[PREPARATIONS,  U.  S.  P. — Liquor  iodinii  compositus :  iodine  360 
gr.,  iodide  of  potassium  1£  troyounce,  distilled  water  1  pint.  Dose,  2  to 
6  minims.  Tinctura  iodinii:  iodine  1  troyounce,  alcohol  1  pint.  Dose, 
1  to  10  minims.  Tinctura  iodinii  composita:  iodine  £  troyounce,  iodide 
of  potassium  1  troyounce,  alcohol  1  pint.  Dose,  5  to  15  minims.  Uh- 
f/uentum  iodinii:  iodine  20  gr.,  iodide  of  potassium  4  gr.,  water  6m., 
lard  1  troyounce.  Uhguentum  iodinii  compositum  :  iodine  15  gr.,  iodide 
'of  potassium  30  gr.,  water  30  m.,  lard  1  troyounce. 

lodoformum. — No  officinal  preparations. — Potassii  Iodidum.^ 

ADMINISTRATION. — Opinions  are  still  divided  as  to  the  best  time  for 
giving  iodides  with  relation  to  food. 

Dr.  Parkes  and  others  recommend  them  to  be  taken  before  meals,  in 
order  to  prevent  decomposition  by  acids,  and  to  secure  dilution  with 
mucus.  Some  give  them  at  bedtime  in  effervescence;  and  again,  others 
find  them  better  borne  by  a  full  stomach.  All  agree  that  they  should  be 
freely  diluted,  and  not  taken  when  there  is  much  starchy  food  in  the 
stomach,  and  if  there  are  not  febrile  or  acute  gastric  symptoms,  a  bitter 
infusion  or  tincture  is  a  good  vehicle;  in  other  cases  rnilk  is  very  suita- 
ble. Large  doses  sometimes  produce  less  iodism  than  small  ones  (Alt- 
haus),  and  arsenic  is  to  some  extent  corrective  of  the  unpleasant  results 
(British  Medical  Journal,  ii.,  1871).  Ethereal  oil,  such  as  that  of 
peppermint,  diminishes  the  mal-odor  of  iodoform  (Medical  Record,  1879). 

ADULTERATIONS. — The  iodides  sometimes  contain  iodates  of  the  re- 
spective alkalies,  and  not  unfrequently  an  excess  of  water,  and,  after 
keeping,  free  iodine  is  developed  to  some  extent  (u.  p.  59) ;  but  of  six 
chance  specimens  analyzed  all  were  found  pure  (British  Medical  Jour- 
nal, ii.,  1870). 


BROMUM— BROMINE,  Br,=80. 

This  element  is  contained  in  sea-water  and  in  some  saline  springs,  as 
in  those  of  Ashby,  Birtley  (Durham),  Woodhall,  and  Kreuznach,  also  in 
sea-weed  and  in  molluscs. 

PREPARATION. — Bromine  is  chiefly  obtained  after  the  crystallization 
of  common  salt,  from  "  bittern  "  or  sea-water  (in  which  it  exists  as  bro- 
mide of  magnesium,  sodium,  and  potassium),  by  passing  through  the 
liquid,  chlorine  gas,  which  sets  free  the  bromine.  The  mixture  is  then 


BROMINE.  95 

shaken  up  with  ether,  which  dissolves  the  bromine  and  rises  to  the  sur- 
face and  is  decanted.  To  this  ethereal  solution  caustic  potash  (or  soda) 
is  added,  and  the  ether  evaporated  off  by  heat.  The  crystals  of  bromide  of 
potassium  thus  obtained  are  treated  with  sulphuric  acid  and  manganese 
oxide,  and  the  liberated  bromine  is  evaporated  and  collected  in  cooled 
receivers. 

The  reactions  are:—  (1)  MgBr2  +  2Cl=MGCl2+2Br.   (2)  6Br-f  6KHO 
.       (3) 


The  potassre  bromas  (KBrO3)  formed  in  the  second  reaction  is  con- 
verted into  potassium  bromide  (KBr)  by  ignition  before  the  final  process. 

CHARACTERS  AND  TESTS.  —  Bromine  is  the  only  non-metallic  element 
which  is  liquid.  It  is  of  brownish  red  color,  very  volatile,  and  emits  an 
irritating,  very  fetid  vapor,  whence  its  name,  Bpo/xos,  a  stench.  It  boils 
at  145.4°  F.  (Pierre)  (139.1°  F.,  Bolas  and  Grove),  not  117°,  as  stated  in 
the  British  Pharmacopoeia.  Iodine,  chlorine,  and  alkalies  decolorize  bro- 
mine, with  formation  of  bromides  and  bromates,  and  in  contact  with 
hydrogen-compounds  it  forms  bromhydric  acid.  Solutions  in  alcohol  and 
ether  (which  liquids  dissolve  bromine  readily)  lose  their  color  in  a  few 
days  with  formation  of  the  same  acid.  Bromine  should  be  kept  in  a 
stoppered  bottle,  and  under  water,  in  which  it  is  only  slightly  soluble. 
At  32°  F.  it  forms  with  water  a  crystalline  hydrate. 

PHYSIOLOGICAL  ACTION.  —  Bromine  coagulates  albumen  and  combines 
with  it  in  a  definite  proportion  of  Br.  23,  albumen  96,  which  compound 
is  soluble  in  caustic  potash,  and  is  colorless  (Glover:  "  Harveian  Essay/' 
1842). 

Undiluted  bromine  quickly-  oxidizes  and  destroys  organic  tissues, 
forming  a  brownish  slough.  With  fatty  substances  hydrobromic  acid  is 
developed.  Bromine  vapor  is  intensely  irritating  to  the  air-passages, 
possibly  on  account  of  its  liberating  free  ozone  on  contact  with  moist 
mucous  surfaces  exposed  to  air.  It  may  cause  coryza,  or  even  laryngitis, 
bronchitis,  or  pneumonia,  and  may  destroy  the  sense  of  smell. 

When  taken  internally  in  doses  of  one  to  two  drops,  well  diluted,  it  has 
a  taste  "truly  horrid"  (Glover),  and  causes  weight  and  heat  at  the  stom- 
ach, often  colic,  shooting  pains  in  the  limbs,  and  itching  in  the  extremi- 
ties; but  after  an  hour  or  so  these  symptoms  are  succeeded  by  a  general 
sense  of  comfort  and  stimulation.  Larger  doses  may  cause  gastritis  with 
symptoms  of  intense  irritation,  prostration,  and  collapse.  Independently 
of  this  local  irritant  effect,  the  physiological  action  of  bromine,  after  ab- 
sorption, is  exerted  mainly  on  the  lymphatic  and  glandular  systems,  their 
functional  activity  being  increased. 

Kohler  mentions  several  experiments  which  have  been  made  with  bro- 
mine, and  says,  "that,  independent  of  its  local  action,  it  exerts,  if  taken 
in  small  doses  for  some  time,  a  strong  action  upon  the  brain,  viz.,  deprcs- 


96  J1ATEKIA    MEDICA    AND    THERAPEUTICS. 

sion  of  the  mental  functions,  sleepiness,  stupor,  prostration,  and  a  state 
resembling  alcoholic  intoxication."  On  the  other  hand,  bromine  does  not 
show  the  peculiar  depressing  action  of  its  potash  salts  on  the  heart,  nor 
their  special  effect  on  the  spine  of  lowering  its  reflex  irritability. 

THERAPEUTICAL  ACTION  (EXTERNAL). — Hospital  Gangrene — Erysi- 
pelas.— The  value  of  bromine  as  an  escharotic  and  caustic  in  these  mala- 
dies was  conclusively  shown  during  the  American  civil  war,  by  Surgeon 
Goldsmith.  The  formula  commonly  employed  was:  "bromine,  1  oz.;  bro- 
mide of  potassium,  160  gr. ;  water,  4  oz."  After  thorough  cleansing  of 
gangrenous  wounds  this  was  applied,  and,  although  very  painful  for  a 
time,  the  pain  was  mitigated  by  bathing,  and  the  malady  was  arrested 
better  by  this  than  by  any  other  means  (Medical  Times,  ii.,  1863,  526). 
The  same  application  was  found  valuable  in  diphtheria  and  erysipelas, 
and  the  liquid,  when  exposed  in  shallow  vessels,  served  also  to  disinfect 
hospital  wards. 

Mr.  Marshall  and  Mr.  Southam  used  a  solution  of  1  scruple  of  bromine 
in  1  oz.  of  spirit  for  unhealthy  wounds,  and  found  it  useful,  but  very 
painful;  its  offensive  smell  is  also  a  drawback  to  its  employment  (Medi- 
cal Times,  ii.,  1868,  p.  93).  The  pure  drug  has  also  been  applied,  and 
acts  well  in  similar  cases,  but  requires  special  precaution  to  carry  the  va- 
por away  from  the  patient  (Lancet,  ii.,  1868). 

Chancre — Epithelioma. — In  the  few  cases  where  a  chancre  can  be, 
with  advantage,  destroyed  in  an  early  stage,  bromine  is  one  of  the  most 
efficient  agents  for  the  purpose. 

Dr.  Wynn  Williams  and  others  have  reported  very  satisfactory  results 
from  the  use  of  local  bromine  injections  into  the  substance  of  epithelial 
cancer  affecting  the  cervix  uteri  (Medical  Times,  ii.,  1866,  p.  488,  and  ii., 
1870,  p.  255).  Dr.  Williams  uses  a  solution  of  12  min.  in  1  dr.  of  recti- 
fied spirit,  injecting  it  through  a  speculum  by  means  of  a  long  glass  sy- 
ringe having  a  platinum  point  (the  nostrils  of  the  operator  should  be 
plugged  with  cotton-wool).  There  can  be  no  question  of  the  good  results 
obtained  by  Dr.  Williams,  but,  as  he  restricted  his  method  to  cases  "  in 
which  the  uterus  was  not  fixed,"  some  doubts  were  thrown  on  the  diag- 
nosis of  cancer  by  Dr.  Playfair  and  others. 

Strmnous  Glands — Chronic  Skin  Diseases. — Ointments  and  lotions 
containing  bromine  have  been  applied  to  glandular  swellings  and  ulcera- 
tions,  and  to  patches  of  chronic  eczema,  with  moderate  success  (Bonnet: 
Bulletin  de  Therapeutique,  1837),  but  severe  symptoms  of  irritation  of 
lungs  and  stomach  have  sometimes  followed,  and  iodine  applications  are 
more  generally  adopted. 

Nasal  Catarrh — Hay-Asthma — Ozcena. — Brominized  inhalations  are 
of  value  in  these  disorders,  and  may  be  employed  in  the  manner  recom- 
mended by  Bartholow.  Half  a  drachm  of  bromine  is  mixed  with  four 
ounces  of  alcohol,  and  a  small  quantity  of  this  placed  in  a  wide-mouthed 


BROMINE.  97 

phial  and  vaporized  by  the  warmth  of  the  hand,  furnishes  a  diluted  vapor 
which  should  be  drawn  up  into  the  nasal  passages. 

Diphtheria — Membranous  Croup. — Brominized  inhalations  and  ex- 
ternal applications  have  been  successfully  used,  especially  by  German 
physicians  in  these  maladies,  and  in  diphtheritic  vaginitis  (British  Medi- 
cal Journal,  ii.,  1872).  Ozanam  used  also  an  aqueous  solution  internally 
(British  and  Foreign  Review,  April,  1869),  and  I  have  myself  seen  excel- 
lent results  with  this  combined  method  of  treatment,  diphtheritic  mem- 
brane disappearing  under  it.  I  have  employed  the  inhalations  and  bro- 
mine internally  every  three  or  four  hours,  using  one  or  two  drachms  of  a 
solution  containing  eight  drops  to  the  ounce,  even  when  the  disease  had 
extended  to  the  bronchi,  and  great  prostration  had  set  in ;  and  sometimes 
I  have  used  the  vapor  and  local  applications  of  bromine  while  giving  iron 
internally,  also  with  very  good  results. 

Redenbacher  has  reported  two  successful  cases  in  which  bromine  and 
bromides  were  useful  (British  Medical  Journal,  i.,  1879). 

THERAPEUTICAL  ACTION"  (INTERNAL) —  Chronic  Arthritis. — Andral 
treated  this  disorder  by  giving  bromine  at  first  in  2-drop  doses,  but  later 
with  as  many  as  60  drops  in  twenty-four  hours.  The  gastric  irritation, 
however,  was  too  severe  to  make  such  treatment  desirable. 

Struma. — Bonnet  recommended  5  to  10  drops  daily  in  cases  of  glandu- 
lar scrofulosis,  conjoining  local  applications  (Bulletin,  1837),  but  the  inter- 
nal use  of  bromine  is  practically  superseded  by  that  of  its  compounds. 
It  is  possible,  however,  that  smaller  and  more  frequent  doses  of  bromine 
than  have  hitherto  been  prescribed  might  give  better  results,  with  avoid- 
ance of  gastric  irritation. 

COMPOUNDS  OF  BROMINE. 

POTASSII  J3ROMIDUM—  BROMIDE  OF  POTAS^LUM,  KBr,=119. 

PREPARATION. — By  adding  bromine  in  slight  excess  to  liq.  potassae, 
and  afterward  heating  with  charcoal,  dissolving,  and  crystallizing.  In 
the  first  part  of  the  process  a  mixture  of  bromide  and  bromate  of  potash 
is  formed,  6KHO  +  Br6— 5KBr+KBrO3  +  3H20,  and  in  the  second  part 
the  bromate  is  deoxidized,  the  bromide  remaining  unaffected. 

CHARACTERS  AND  TESTS. — It  occurs  in  cubical  crystals,  resembling 
those  of  the  iodide,  but  smaller.     When  well  kept  they  are  transparent 
or  white,  but  commonly  have  a  tinge  of  yellow  from  some  free  bromine. 
They  have  a  saline,  bitter  taste,  and  high  diffusion  power.     They  contain 
66  per  cent,  of  bromine.     Chlorine  water  added  to  the  crystals  liberates 
bromine,  which  will  impart  an  orange-red  color  to  chloroform,  ether,  or 
sulphide  of  carbon.     The  starch-test  would  detect  iodine,  which  used  to> 
be  a  frequent  adulteration. 
VOL.  I.— 7 


98  MATERIA   MEDIC  A    AND    THERAPEUTICS. 


AMMONII  DROMIDUM— BROMIDE  OF  AMMONIUM,  NH<Br,=98. 

PREPARATION. — By  saturating  hydrobromic  acid  with  ammonia — HBr 
x  NH4HO=NH4Br  +  H4O. 

CHARACTERS  AND  TESTS. — It  occurs  in  white,  colorless  crystals,  which 
gradually  become  yellowish;  is  rather  more  disagreeable  to  the  taste 
than  the  potassium  salt;  answers  to  the  tests  mentioned,  but  effervesces 
with  acids. 

Sodii  Bromidum — Bromide  of  Sodium,  NaBr  (not  officinal).  Crystal- 
lizes like  the  analogous  salt  of  potassium;  it  is  less  bitter  in  taste;  con- 
tains more  bromine  (78  per  cent.). 

Lithice  Bromidum — Bromide  of  Lithia  (not  officinal)  is  crystalline, 
white,  soluble,  and  contains  a  larger  proportion  of  bromine  than  any  other 
compound  (92  per  cent.  Weir  Mitchell). 

Calcii  Bromidum — Bromide  of  Calcium  (not  officinal)  is  white,  very 
soluble,  in  fact  deliquescent.  Readily  decomposes  on  exposure,  becoming 
brown  in  color;  occurs  in  Kreuznach  and  Vals  water;  is  less  stable  than 
the  potassium  salt,  and  therefore  more  active  (Hammond). 

Magnesice  JBromidum — Bromide  of  Magnesia. — This  salt  is  the  main 
source  of  the  metalloid,  and  is  especially  abundant  in  the  water  of  the 
Dead  Sea;  it  is  found  also  in  the  Ashby  and  Kreuznach  waters. 

Besides  these,  there  are  many  metallic  bromides,  such  as  those  of  iron, 
zinc,  mercury,  and  lead;  and  many  organic  bromides,  such  as  those  of 
camphor,  morphia,  quinine,  and  strychnia.  Their  properties  are  chiefly 
those  of  the  base,  but  modified  somewhat,  so  as  to  act  more  favorably  on 
the  nervous  system.  Bromhydric  acid  is  another  combination  recently 
introduced  (British  Medical  Journal,  July,  1876)  (v.  p.  119).  Hydro- 
bromic ether  is  said  to  be  an  efficient  and  comparatively  safe  anaesthetic 
(Levin). 

ABSORPTION  AND  ELIMINATION. — The  alkaline  bromides  are  readily 
absorbed,  and  have  been  found  in  the  urine  and  saliva  five  minutes  after 
a  dose  of  15  gr.  (Rabuteau);  in  ten  minutes'  time  the  reactions  were  very 
manifest.  Bowditch  drew  blood  from  the  carotid  of  an  animal  six  min- 
utes after  10  gr.  had  been  taken,  and  calculated  that  even  in  that  time  a 
third  of  the  dose  had  passed  into  the  circulation  (Boston  Journal,  Octo- 
ber, 1868).  They  are  usually  eliminated  unchanged,  and  Voisin  has  ob- 
tained cubical  crystals  of  the  potassium  salt  from  the  urine  of  patients 
taking  it.  The  rate  of  elimination  varies.  Tn  some  experiments  already 
mentioned,  the  urine  gave  traces  of  the  drug  in  ten  minutes;  in  others 
thirty  minutes  was  the  earliest  period,  in  others  twenty-five  hours  (Bow- 
ditch).  The  excretion  of  single  large  doses  is  usually  complete  in  one  or 
two  days  (Chauvet,  Amory),  though  minute  quantities  have  been  detected 
in  the  urine  for  three  or  four  weeks  afterward  (Rabuteau).  If  the  drug 


BROMINE.  99 

lias  been  taken  continuously  for  some  time,  the  period  of  its  excretion  is 
prolonged:  thus  Namias  found  it  continue  for  fourteen  days  ( Gazette 
Hebdomadaire,  1868),  and  renal  disease  so  far  impedes  its  excretion  that 
upwards  of  thirty  days  may  be  required  for  its  completion.  Dr.  Steven- 
son "  detected  bromides  in  the  urine  of  a  child,  passed  about  four  weeks 
after  the  medicine  was  discontinued  "  (Lees  :  "  Pathological  Society's 
Transactions,"  1877). 

As  evidence,  also,  of  the  slow  elimination  of  these  salts,  Drs.  Crocker, 
Lees,  Barlow,  myself  and  others,  have  noted  the  increase,  or  even  the 
chief  development,  of  the  rash  sometimes  produced  by  them  after  the 
discontinuance  of  the  drugs.  The  elimination  of  bromides  is  certainly 
slower  than  that  of  iodides.  It  occurs  not  only  by  the  kidneys  and  the 
saliva,  but  also  by  the  mammary,  lachrymal,  and  sudoriparous  glands,  and 
by  mucous  membranes — 'by  the  last  especially  in  the  case  of  the  ammo- 
nium salts.  In  exceptional  instances  the  salts  have  been  decomposed  in 
the  system  and  free  bromine  eliminated  in  the  breath.  The  alkaline 
compounds  do  not  usually  pass  by  the  faeces  unless  diarrhoea  occur;  but, 
if  metallic  bromides  be  taken,  the  metal  passes  chiefly  by  the  bile  and  the 
motions. 

Thus,  when  experimenting  with  bromide  of  iron,  Namias  found  bromine 
abundantly  in  the  urine,  but  iron  scarcely  at  all.  The  same  observer,  ex- 
amining the  body  of  a  man  who  died  while  taking  bromide  of  potassium, 
found  that  salt  in  all  the  fluids,  as  well  as  in  the  brain,  liver,  lungs,  and 
other  viscera  (Comptes  Kendus,  tome  Ixx.).  After  very  large  doses,  an 
unabsorbed  portion  has  been  found  in  the  intestine. 

PHYSIOLOGICAL  ACTION  (INTERNAL). — Digestive  System. — Doses  of  5 
to  15  gr.  of  the  alkaline  bromides  are  well  borne  by  the  stomach,  but  up- 
ward of  20  or  30  gr.  will  often  cause  irritation  and  nausea,  with  sense  of 
weight  and  coldness,  or  later  of  warmth.  At  first  the  gastric  secretions 
are  rather  lessened  and  appetite  slightly  increased,  but  after  a  time  there 
is  anorexia,  and  gastric  catarrh  and  diarrhoea  may  occur,  especially  with 
the  potassium  salt.  Bromide  of  sodium  increases  thirst  as  the  chloride 
does.  The  sensibility  and  the  reflex  movements  of  the  fauces  and  pharynx 
become  much  lessened  under  the  full  influence  of  the  bromides,  and  even 
from  their  continued  local  application.  If,  however,  these  parts  are  in- 
flamed, a  strong  solution  may  prove  very  painful. 

Nervous  System. — The  action  of  bromides  on  the  nervous  system, 
especially  of  the  lower  animals,  has  been  carefully  studied  by  many  ob- 
servers, but  with  different  and  somewhat  confusing  results.  Thus,  while 
Damourette,  Pelvet,  and  R.  Amory  conclude  that  the  functions  of  nerve- 
tissue  become  paralyzed  by  its  direct  local  application  (Bulletin  Thera- 
peutique,  tome  Ixxiii.,  and  "  Essay  on  Bromide,"  1872),  Saison  finds  no 
trace  of  such  paralysis  (Du  Bromure:  These,  1868);  and  while  Laborde 
and  Purser  are  satisfied  that  reflex  function  is  early  abolished  (Archives 


100  MATERIA   MEDIC  A   AND    THERAPEUTICS. 

de  fhysiol.,  tome  i.,  and  Dublin  Journal,  1869),  Bill  holds  this  to  be  un- 
proven,  and  argues  that  results  with  frogs  are  but  little  guide  to  effects 
on  men  (American  Journal,  July,  18G8). 

I  believe  myself,  that  in  this  instance  there  is  much  analogy  in  the 
action  of  the  drug  on  men  and  animals,  and  a  careful  consideration  of  the 
evidence  before  us  warrants  the  following  statements. 

In  batrachians,  the  bromides,  when  injected  under,  or  absorbed  through 
the  skin,  after  producing  spasm,  exert  a  local  paralyzing  effect  on  the 
neighboring  tissues,  whether  nervous  or  muscular.  If  the  injection  be 
made  close  to  the  brain  or  to  the  cord,  the  centre  which  is  nearest  will  be 
paralyzed  soonest;  but  if  absorption  occur  at  a  distance,  e.g.,  through  the 
web  of  foot,  then  reflex  power  is  first  lost,  so  that  pinching  or  irritation 
does  not  excite  the  usual  contractions.  The  periphery  of  sensory  nerves 
loses  its  sensibility  very  soon  afterward;  then  the  motor  tract  of  the  cord 
and  motor  nerves  are  affected,  and  lastly  the  cerebrum.  Most  of  the 
characteristic  effects  of  the  drug  may  be  seen  on  frogs  after  the  medulla 
is  divided  from  the  brain,  but,  if  it  be  left  undivided,  the  persistence  of 
some  voluntary  power,  after  the  cessation  of  reflex  function,  is  made 
evident  by  movements  even  after  apparent  death. 

In  warm-blooded  animals  the  demonstration  of  early  loss  of  reflex 
power  is  not  so  complete,  but  there  is  evident  impairment  of  sensibility 
and  of  cerebral  action,  with  partial  paralysis,  especially  of  the  hind 
limbs. 

In  maw,  the  earliest  effects  of  full  doses  on  the  nervous  system  are 
usually  seen  in  impaired  sensibility,  especially  of  mucous  surfaces,  such 
as  the  fauces  and  pharynx,  the  conjunctiva,  and  the  urethral  membrane. 
It  is  possibly  most  marked  in  these  regions  because  the  drug  is  largely 
eliminated  there,  but  loss  of  tactile  sensibility  is  also  sometimes  observed 
in  the  palms  and  the  soles.  Affection  of  the  nerve-centres  is  shown,  sooner 
or  later,  by  languor,  lassitude,  and  drowsiness;  giddiness  is  complained 
of,  and  exceptionally  there  may  be  cerebral  excitement;  mental  working 
power  is  temporarily  impaired,  so  that  ordinary  accounts  become  puzzling 
and  memory  fails.  The  amount  of  the  drug  that  produces  such  symptoms 
varies  in  different  persons.  Dr.  Lockhart  Clarke  has  noted  them  from 
half-drachm  and  drachm  doses,  but  usually  they  are  not  seen  until  after 
much  larger  quantities  have  been  absorbed.  The  impaired  nerve-condition 
is  known  as  "  bromism,"  and  when  developed  in  an  extreme  degree,  the 
special  senses,  sight  and  hearing,  are  greatly  dulled,  reflex  and  motor  power 
are  almost  wholly  lost,  and  the  cerebral  state  is  one  of  absolute  apathy 
and  indifference  bordering  upon  idiocy.  As  a  rule,  these  serious  symp- 
toms subside  quickly  on  omission  of  the  drug. 

In  a  case  said  to  be  of  chronic  bromine-poisoning  there  were  vertigo, 
amaurosis,  and  some  loss  of  co-ordination  and  sensation  (Medical  Record, 
1879). 


BROMINE.  101 

In  seeking  for  an  explanation  of  the  mode  of  action  of  bromide,  it  is 
clear  that  we  must  go  farther  than  the  contraction  of  minute  vessels  in 
the  nerve-tissue;  we  may  grant  that  it  produces,  in  certain  doses,  such  a 
contraction,  and  may  therefore  believe  that  it  irritates  or  stimulates  vaso- 
motor  nerves,  but,  besides  this,  must  be  admitted,  for  toxic  doses  at  least, 
a  direct  sedative  depressing  action  on  the  cerebro-spinal  system,  both 
central  and  peripheral,  and,  in  some  instances,  the  action  on  the  vaso- 
motors  is  also  paralyzing,  and  is  accompanied  by  relaxation  of  capillaries 
and  local  congestions.  It  is  thus  that  we  may  explain  the  exceptional  oc- 
currence of  diarrhoea  or  diuresis  under  bromides,  and  more  particularly 
the  retinal  congestions  found  by  Dr.  Nicol  after  doses  of  \  to  1  dr.  (Medico- 
Chirurgical  Transactions,  ii.,  1872);  but  this  point  requires  further  in- 
vestigation. 

Nothnagel  says  the  temperature  always  goes  down  after  large  doses 
in  men  and  animals — after  10  grammes  (2$  dr.)  by  0.5°  to  0.8°  C.,  after  15 
grammes  by  1.2°C.  (Krosz). 

Circulatory  System. — In  a  frog,  if  strong  solutions  be  injected  near 
the  cardiac  region,  the  heart  is  suddenly  arrested  in  diastole,  but  under 
a  slower  distal  absorption  this  does  not  occur,  nor  is  there  evidence  of  the 
specific  paralyzing  effect  upon  the  heart  contended  for  by  Eulenburg. 
On  the  contrary,  the  heart  has  been  found  beating  one  or  two  hours  after 
complete  paralysis  of  the  nervous  system  and  of  respiration  (Damourette, 
Saison).  The  heart-action  is  rendered  slower,  but,  as  a  rule,  the  capillaries 
are  narrowed  before  this  slowing.  It  is  not  the  soaking  through  of  the 
cardiac  muscles  by  bromide  of  potash  that  produces  these  effects  (as  it 
does  in  the  experiments  on  the  frog  mentioned  above),  but  the  gradual 
lowering  of  the  spinal  reflex  irritability.  The  observers  just  named,  as 
well  as  Meuriot,  Hammond,  and  Amory,  have  witnessed  the  narrowing  of 
vessels  in  the  web,  the  tongue,  or  the  brain  of  frogs  or  dogs;  but  others 
have  failed  to  see  this,  and  Dr.  H.  C.  Wood  considers  the  present  proof  in- 
sufficient; neither  does  the  observation  that  divided  capillaries  of  abromin- 
ized  frog  bleed  less  than  normal  ones  seem  free  from  criticism,  for  he  sug- 
gests that  lowered  heart-action  would  account  for  lessened  bleeding.  But, 
these  observations  apart,  I  think  the  surface-pallor  that  follows  the  use 
of  bromides,  and  the  lessening  of  secretion  and  discharge,  point  strongly 
in  the  same  direction  (narrowing  of  vessels).  There  is  also  post-mortem 
evidence  of  lessened  blood  in  capillaries  when  influenced  by  bromide  (Sai- 
son), and  we  may  quote,  too,  the  clinical  fact  that  bromides  relieve  many 
forms  of  capillary  congestion,  especially  cerebral  and  uterine,  whereas  in 
patients  with  cerebral  anaemia  the  effects  are  often  distressing.  Thus, 
while  Dr.  Wood  considers  capillary  contraction  to  be  "  somewhat  proba- 
ble," I  hold  it  to  be  more  clearly  ascertained. 

That  the  heart-action  and  the  general  circulation  are  slowed  in  the 
lower  animals  is  also  evident  from  many  experiments  (Damourette  and 


102  MATERIA   MEDICA   AND   THERAPEUTICS. 

Pelvet,  loc.  cit.,  and  Schouten:  Schmidt's  Jahrbuch,  Bd.  cliv.,  p.  11).  This 
is  more  marked  with  the  potassium  salt  than  with  the  others,  and  may 
be  largely  credited  to  the  alkali;  the  bromide  of  sodium  has  compar- 
atively slight  effect  in  this  direction  (Eulenburg,  Rabuteau).  In  man, 
the  depressing  effect  of  any  bromides  on  the  circulation  is  not  constant. 
Pletzer  noticed  it  (Schmidt,  August,  1868),  and  Bartholow  records  a  de- 
pression of  10  to  20  beats  per  minute  after  a  dose  of  2  dr.;  but  Dr.  Bill, 
Dr.  Voisin,  Dr.  Russell  Reynolds,  and  others  have  failed  to  observe  such 
a  result  with  doses  of  20  gr.  and  upwards,  continued  for  some  time.  It 
is  evident  that  circulatory  depression  is  a  less  constant  and  characteristic 
effect  of  the  bromides  than  nerve-sedation. 

Generative  System. — Speaking  generally,  we  may  say  that  bromides 
act  as  sedatives  upon  the  genital  system,  and  diminish  the  sexual  feelings 
and  the  power  of  erection,  though  the  secretion  of  the  testicles  is  not 
lessened  (Rabuteau).  But  we  must  recognize  that  genital  excitement 
may  arise  either  from  eccentric  cause  (as  urethral  irritation,  rectal  or 
ovarian  congestion,  etc.),  or  from  a  centric  cause  in  the  mind,  cord,  or 
brain  itself.  It  is  the  former  that  is  controlled  by  bromide,  and  there  is 
some  reason  to  think  with  Dr.  Bill  that  its  effect  is  mainly  local,  and  ex- 
erted through  the  mucous  membrane  of  the  urethra,  although,  no  doubt, 
some  effect  may  be  attributed  to  a  lessening  of  congestion  in  the  spinal 
cord  (v.  p.  133).  The  degree  of  sedation  induced  by  bromides  varies  in 
different  men  and  in  male  animals,  and  is  shown  only  under  the  influence 
of  large  doses.  It  is  said  not  to  be  exerted  in  the  female  sex,  though 
there  is  clinical  evidence  of  these  medicines  lessening  uterine  and  ovarian 
congestion  and  irritation. 

Action  on  Secretion  and  Excretion. — The  primary  effect  of  moderate 
doses  of  bromide  is  to  lessen  most  of  the  secretions  (Bowditch  and 
others),  although,  as  a  secondary  effect,  or  after  very  large  doses,  they 
may  be  increased.  There  is  no  lachrymation,  salivation,  or  catarrh  from 
a  pure  salt,  as  there  is  from  the  iodides,  for  bromides  are  more  stable,  and, 
although  also  eliminated  by  mucous  membranes,  do  not  part  with  free 
bromine  on  their  surface.  The  mouth  is  rendered  rather  drier  than  usual, 
especially  by  the  sodium  salt.  The  amount  of  mucus  in  the  intestinal 
canal  is  also  lessened,  so  that  constipation  is  not  infrequent  at  first.  The 
secretion  of  milk  is  lessened  by  the  internal  and  local  use  of  bromide 
of  potassium  (Tyler  Smith:  Medical  Times,  i.,  1861).  With  regard  to 
the  amount  of  urine  excreted,  the  usual  result  is  that  with  small  or  mod- 
erate doses  no  increase  can  be  made  out,  while  with  large  or  long-con- 
tinued ones,  diuresis  occurs.  Dr.  Bowditch  suggests  that  a  secondary 
hypersemia  is  determined  more  readily  in  the  kidneys  than  in  other  parts, 
and  Pletzer  has  reported  albuminuria  in  some  instances. 

Bromides  tend  to  lessen  vesical  irritability,  and  so  to  render  micturi- 
tion less  frequent,  though  the  amount  passed  may  be  really  larger  than 


BROMINE.    '  103 

usual.  On  the  other  hand,  very  large  doses  may  so  far  paralyze  the 
sphincter  as  to  occasion  incontinence. 

Excretion  of  Urea  and  Carbonic  Acid — Action  on  Nutrition. — From 
the  experiments  of  Dr.  Bill  and  Professor  Rabuteau,  it  appears  that 
tissue-change  is  retarded  under  the  influence  of  bromides.  The  former 
especially  noted  that  the  carbonic  acid  eliminated  was  decidedly  less  than 
normal,  and  this  independently  of  diminished  nerve-power,  and  not  pro- 
portionately to  the  dose,  as  it  is  with  morphia  and  its  congeners.  For 
some  time  after  ceasing  the  medicine  the  excretion  of  the  gas  was  in- 
creased, implying  that,  for  a  time,  "  the  way  through  the  lungs  was 
barred,"  and  this  he  attributed  to  vital  causes,  "  limited  in  their  seat  and 
effects  to  nerve-elements  in  the  pulmonary  mucous  membrane." 

Rabuteau  found  that  while  his  average  daily  excretion  of  urea  was 
21.25  grammes,  the  mean  amount  passed  while  he  took  a  daily  dose  of 
15  gr.  of  bromide  of  potassium  was  19.52  grammes;  for  a  fortnight  after 
omitting  the  drug  it  remained  at  about  20  grammes;  in  the  third  week  it 
resumed  a  normal  proportion,  and  in  the  fourth  week  exceeded  this. 
Rabuteau  connected  the  primary  result  with  slowing  of  circulation  and 
respiration;  it  was  not  accompanied  by  increased  quantity  of  urine. 

Dr.  Gibb  found  the  ammonium  salt  diminish  body-weight  "  by  favor- 
ing absorption  of  fat  "  (Lancet,  i.,  1863).  If  this  be  so,  we  should  expect 
carbonic  acid  and  urea  to  be  increased  in  amount  (contrary  to  the  above 
results  from  the  potassium  salt);  but  he  gave  only  small  doses  (3  to  5 
gr.),  and  his  results  need  confirmation.  Bartholow  found  that  assimila- 
tion was  retarded  by  the  continued  use  of  bromides,  and  he  traced  ema- 
ciation to  this  cause.  1  have  sometimes  noted  emaciation  from  these 
medicines;  but  it  is  by  no  means  invariable,  as  shown  in  ten  patients  at 
Hayward's  Heath  Asylum,  who  took  daily  doses  of  less  than  1  dr.  of  the 
potassium  salt.  Ordinary  secretion  and  excretion  were  not  affected,  but 
all  these  patients  increased  in  weight;  and  in  another  series  of  patients 
who  took  more  than  1-dr.  doses,  some  lost  weight  and  some  did  not  (Dr. 
Williams).  The  increase  of  weight  would  accord  with  the  conclusions  of 
Bill  and  Rabuteau,  but  minute  analyses  were  not  made. 

Cutaneous  System. — Perspiration  is  diminished  under  bromide  of 
potassium.  Various  kinds  of  eruption,  erythematous  or  acneiform  in 
character,  are  commonly  traced  to  this  drug,  and  although  several  ob- 
servers maintain  that  they  are  wholly  due  to  some  contained  iodide,  they 
seem  in  greater  or  less  degree  inseparable  from  bromide  medication,  and 
occur  with  almost  equal  frequency  after  the  ammonium,  sodium,  or  other 
compounds. 

They  affect  mostly  the  face,  the  arms,  the  back,  and  the  buttocks,  but 
may  be  general.  They  present  papules,  vesicles  containing  sebaceous 
matter  (seborrhrea — Fox),  or  pustules,  and  even  crusted  tubercles  of  car- 
buncular  character,  and  have  been  termed  "  confluent  acne  "  (Cholmeley) 


104  MATEIUA    MEDICA    AND    THERAPEUTICS. 

and  "  molluscoid  acne  "  (Neumann).  Voisin  distinguishes  five  different 
kinds  of  "  bromide  rash  "  (Archives  Generates,  1866-67).  Usually  there 
is  a  hard,  red  swelling,  with  a  small  point  of  suppuration  in  the  centre; 
this  may  be  quite  small — a  mere  papule — or  of  large  size.  An  eruption 
of  this  kind  has  occurred  in  a  child  at  the  breast,  whose  mother  was  tak- 
ing the  medicine  and  who  was  not  herself  affected  (Lancet,  ii.,  1874,  p. 
657).  A  more  rare,  but  still  recognized  form,  is  that  of  erythematous 
patches,  which  may  be  local  or  general  (Veiel:  Medical  Times,  ii.,  1874, 
p.  152;  i.,  1878,  p.  151). 

SYNEEGISTS. — The  sedative  action  of  the  alkaline  bromides  on  the 
nervous  system  is  assisted  or  modified  favorably  under  certain  conditions 
by  chloral,  cannabis,  and  opium;  their  regulating  effect  upon  vaso-motor 
nerves,  especially  by  quinine;  their  depressant  effect  upon  the  circulation 
is  aided  by  aconite,  gelseminum,  veratrum  viride,  and  digitalis,  also  by 
nitrate  of  potash  and  allied  salts;  their  alterative  power  is  increased  by 
cod-liver  oil,  iodides,  and  alkalies,  though  iodides  would  interfere  with 
sedative  action. 

ANTAGONISTS. — True  stimulants,  such  as  alcohol,  ether,  and  coffee, 
which  tend  to  induce  arterial  congestions,  oppose  the  action  of  bro- 
mides; thebaine  and  narcotine,  strychnia,  and  nicotine,  are  also  anti- 
dotal. Strychnia  especially  has  an  opposite  effect  on  the  cord  and 
medulla  oblongata,  though  without  a  direct  action  on  the  brain  or  the 
muscles.  The  difference  in  the  capillaries  of  the  spinal  centres  post-mor- 
tem, after  using  the  two  drugs,  was  especially  noted  by  Saison;  under 
bromide  the  vessels  were  scarcely  visible,  under  strychnia  intensely  con- 
gested. 

Atropia  antagonizes  in  some  degree  bromal  hydrate  (Hughes  Bennett: 
British  Medical  Journal,  i.,  1875),  and  ergot  is  opposed,  in  its  full  ac- 
tion, to  bromides — although  any  of  the  above-named  drugs  may  at  times 
be  usefully  combined  with  them,  and  made  to  modify  their  ordinary  ac- 
tion for  certain  therapeutical  results.  This  is  evidenced  by  clinical  expe- 
rience. 

Dr.  Bill  argues  that  chloride  of  sodium  is  antagonistic  to  bromide  of 
potassium,  and  that  the  latter  remains  longer  in  the  system  if  the  former 
salt  be  avoided  {American  Journal,  1868). 

The  value  of  arsenic  in  curing  and  preventing  bromide  rash  has  been 
asserted  by  several  observers,  and  lately  Dr.  Gowers  has  published  illus- 
trative cases  (Lancet,  i.,  1878). 

THERAPEUTICAL  ACTION  (EXTERNAL). — Morbid  Growths,  etc. — Bro- 
mide of  potassium,  applied  in  fine  powder  to  indolent  ulcerations  and 
morbid  growths  with  raw  surface,  is  said  to  act  well  and  painlessly  as  an 
alterative  or  caustic.  An  epithelioma  has  been  successfully  treated  in 
this  manner  (Perrant:  Medical  Times,  ii.,  1876,  p.  368). 

Mixed  with  simple  ointment  (1  part  in  5),  or  with  glycerin,  it  forms  a 


BROMINE.  105 

sedative,  somewhat  astringent  application  for  painful  and  sloughing  ul- 
cers, also  for  painful  conditions  of  mucous  membrane,  haemorrhoids,  and 
anal  fissure,  and  for  chronic  eczema  and  acne. 

A  lotion  containing  1  part  to  50  of  water  is  said  to  restrain  hemor- 
rhage (Lancet,  ii.,  1876,  p.  474). 

THERAPEUTICAL  ACTION  (INTERNAL). —  In  1826,  Barthez,  Andral, 
and  some  few  other  (French)  observers,  ascertained  that  the  bromide  of 
potassium  could  relieve  arthritic  pain,  and  Pourche  found  it  useful  in 
bronchocele.  Dr.  Robert  Williams  (of  St.  Thomas'  Hospital)  reported 
such  success  with  it  in  the  treatment  of  enlarged  spleen,  as  to  contribute 
to  its  introduction  into  the  London  Pharmacoposia  of  1835,  and  yet  it  is 
instructive  to  remark,  that  so  little  clinical  evidence  of  its  value  was  ob- 
tained by  others,  that  the  medicine  was  omitted  in  that  of  1851.  Puche, 
however,  found  it  to  cause  partial  anaesthesia;  and  Thielman,  a  Russian 
physician,  noted  its  sedative  influence  on  the  generative  system;  and 
from  these  suggestions  Sir  Charles  Locock  was  led  to  use  it  in  epilep- 
tic or  epileptiform  attacks,  connected  especially  with  ovarian  or  uterine 
excitement,  and  the  mention  of  his  successful  results  at  the  Medico-Chi- 
rurgical  Society  in  1857  was  practically  the  commencement  of  general 
knowledge  upon  the  subject. 

Epilepsy. — For  this  malady  the  bromides  are  now,  by  common  con- 
sent, held  to  be  the  most  generally  reliable  remedies.  They  give  the 
best  results  in  sthenic  cases  of  uncertain  causation,  when  convulsive  at- 
tacks are  very  violent,  but  have  not  become  chronic.  Attacks  connected 
with  tumor,  or  injury,  or  organic  lesion,  are  also  more  or  less  relieved, 
probably  in  proportion  to  the  amount  of  hyperaemia  present.  Dr.  Wilks 
found  better  results  from  bromides  in  traumatic  cases  than  in  any  other 
(Medical  Times,  ii.,  1861,  p.  635),  and  Dr.  Broadbent  noticed  the  same 
fact  (Lancet,  i.,  1866,  p.  92).  Where  there  is  excentric  irritation,  as  in 
the  generative  system  or  the  abdominal  organs,  benefit  is  almost  always 
obtained,  and  Dr.  Bill  has  compared  the  action  of  bromides  in  such  cases 
to  that  of  a  ligature,  interrupting  communication  between  an  impression 
or  "aura,"  and  the  brain;  they  seem  to  diminish  not  only  conductive, 
but  reflex  function.  In  a  case  in  my  own  practice,  where  a  large  uterine 
fibroid  produced  alarming  epileptiform  symptoms,  opium  invariably  in- 
creased the  spasms,  but  bromides  relieved  quickly. 

Minor  forms  of  epilepsy,  as  "  petit  mal,"  evidenced  by  transient  ver- 
tigo or  loss  of  consciousness,  with  perhaps  some  spasm,  but  not  true  con- 
vulsion, are  not  so  certainly  relieved;  and  when  the  epileptic  attacks 
occur  only,  or  chiefly,  at  night,  and  at  long  intervals,  bromides  are  not  al- 
ways the  best  remedies;  also  in  very  chronic  cases  of  many  years'  dura- 
tion, they  can  usually  do  little  more  th'an  modify  the  character  of  the  at- 
tacks. When  the  patient  has  become  nerveless  and  stupid,  belladonna 
has  the  advantage  over  bromides,  and  when  there  is  marked  anasmia  or 


106  MATERIA   MEDIC  A   AND    THEKAPEUTICS. 

profound  depression,  they  are  not  desirable.  Nux  vomica,  or  strychnia, 
in  small  doses,  will  act  better,  especially  if  consciousness  be  not  completely 
lost  during  the  fits.  It  must  be  noted,  however,  that  according  to  statis- 
tics recently  published  by  Dr.  A.  Hughes  Bennett,  all  varieties  of  the  dis- 
order— petit  mal,  nocturnal  or  chronic  epilepsy — have  shown  good  results 
in  large  proportion  under  bromide  treatment  (Edinburgh  Medical  Jour- 
nal, February  7,  1881). 

Supposing  the  case  be  one  suitable  for  this,  it  is  important  for  success 
that  it  should  be  carried  out  thoroughly,  in  sufficient  doses,  and  contin- 
ued sufficiently  long.  It  must  not  be  interrupted  as  useless  in  any  case, 
unless  distinct  evidence  of  its  physiological  effect  has  been  obtained  with- 
out relief  to  the  symptoms.  The  production  of  drowsiness,  or  of  a  char- 
acteristic skin-eruption,  may  be  taken  as  some  guide,  but  a  better  one 
will  be  found  in  the  degree  of  insensibility  produced  in  the  fauces;  if  no 
irritation  or  retching  is  caused  by  touching  the  uvula  or  pharynx,  then 
probably  the  patient  is  under  bromic  influence.  From  10  to  40  gr.  thrice 
daily  is  an  average  limit,  more  being  given  at  night-time,  if  necessary. 
At  first,  even  larger  quantities  may  be  required,  and  many  instances  of 
success  from  very  large  doses  are  on  record.  Puche  and  other  French 
physicians  have  given  100  and  200  gr.,  but  not  without  some  vomiting  and 
prostration  (Medical  Times,  i.,  1874).  Dr.  Squibb  found  GO  gr.  act  well 
when  less  failed;  and  he  notes  that,  if  the  medicine  needs  to  be  omitted 
for  a  time,  it  should  be  resumed  at  the  full  dose  again.  Dr.  Farquhar- 
son  gave  30  gr.  four  times  daily  with  benefit,  to  a  child  aged  five;  and 
Dr.  F.  Beach,  at  the  Clapton  Asylum,  commonly  gives  15  gr.  every  two 
hours  for  a  time,  and  1  or  2  dr.  during  a  paroxysm  (British  Medical 
Journal,  ii.,  1877).  Thirty  grains  thrice  daily  have  been  taken  for  twelve 
years,  and  although  before  treatment  the  patient  was  incapable  of  work, 
he  became  equal  to  the  conduct  of  an  ordinary  business  (ibid,  p.  G55). 
There  was  no  effect  on  the  sexual  power.  I  have  often  myself  given 
similar  large  doses,  and  for  a  long  period;  but  there  is  no  one  rule  to  fol- 
low, as  I  have  found  10  gr.  act  as  effectively  in  some  cases  as  GO  gr.  in 
others.  Sometimes  5  gr.  will  cause  troublesome  acne. 

When  the  attacks  are  once  controlled,  a  single  daily  dose  of  from  20 
to  60  gr.  will  usually  suffice  to  keep  up  the  effect,  and  may  have  to  be 
continued  for  many  'months  or  years.  Bromide,  indeed,  has  been  well 
called  the  "  food  of  the  epileptic,"  and  sometimes  needs  to  be  taken  as 
regularly  as  food;  still,  an  occasional  intermission — one  or  two  days  in  a 
week  or  fortnight — is  usually  desirable,  for  thus  the  effect  of  the  medicine 
is  better  preserved,  with  less  injury  to  the  patient.  It  is  necessary  to 
watch  carefully  its  effect  on  the  general  health,  and  to  omit  it,  or  at  least 
to  lessen  the  dose,  if  the  skin  should  be  much  affected,  the  extremities 
become  cold,  or  anaemia,  prostration,  or  diminished  sexual  power  be  traced 
to  it.  In  exceptional  cases  there  has  been  developed,  under  bromides, 


BROMINE.  107 

a  peculiar  general  irritability  of  asthenic  character,  or  even  an  excited 
condition  resembling  mania  (Sequin,  Voisin).  Minor  symptoms,  such  as 
headache,  "  stuffiness  "  of  head,  lachrymation,  and  gastric  irritation,  have 
been  connected  with  the  use  of  a  preparation  adulterated  with  iodide 
(Legrand  du  Saulle:  Medical  Times,  i.,  1872,  p.  319).  If  during  the 
omission  of  treatment  convulsion  threatens  to  return,  bromide  should  be 
at  once  resumed,  but  perhaps  in  a  different  combination. 

For  weakness  or  anaemia,  quinine  or  iron  may  be  added  with  advantage. 
Strong  coffee  hinders  development  of  bromism  (Echeverria),  and  arsenic 
in  small  doses  will  prevent  or  cure  bromic  acne.  The  addition  of  a  sma.ll 
quantity  of  strychnia  to  the  bromide  is  recommended  by  Brown-Sequard 
and  by  Tyrrell  (Medical  Times,  i.,  1871,  p.  3G);  it  certainly  should  be  only 
in  small  doses,  or  it  would  antagonize  the  bromide.  Nux  vomica,  in  my 
opinion,  holds  but  a  doubtful  place  in  the  treatment  of  epilepsy;  it  will 
improve  digestion,  and  give  "  tone  "  to  a  relaxed  nerve-system,  and  relieve 
convulsive  attacks  when  consciousness  is  not  wholly  lost,  but  in  such  cases 
it  acts  better  alone  than  with  bromides. 

Several  alkaline  bromides  taken  together  sometimes  act  better  than 
any  single  one  (Brown-Sequard),  and  I  have  often  found  advantage  from 
combining  the  potassium  and  ammonium  salt.  General  experience  has 
not  yet  corroborated  the  observations  of  Weir  Mitchell  as  to  the  superior 
efficacy  of  the  lithium  salt,  nor  of  Hammond  as  to  the  bromide  of  calcium, 
but  they  may  be  useful  as  alternatives.  The  bromide  of  sodium  is  less 
depressing  to  the  heart  than  that  of  potassium,  as  has  been  illustrated  by 
Dr.  Hollis  (Practitioner,  1878). 

I  cannot  speak  well  of  the  addition  of  belladonna,  often  recommended. 
That  medicine  has  its  own  field  in  cases  rather  acute  in  character,  difficult 
to  diagnose,  but  on  the  border-land  between  epilepsy  and  eclampsia.  It 
is  especially  useful  when  they  are  traced  to  sudden  fright,  and  are  at- 
tended with  congestive  headache  between  the  attacks,  and  again  in  the 
eclampsia  of  robust  plethoric  children  with  cerebral  congestion;  but, 
when  given  in  combination  with  bromides,  I  have  found  its  action  unreli- 
able and  confusing.  Dr.  Beaman  combined  lactucarium  and  lupulin 
(Lancet,  ii.,  1867),  and  the  addition  of  digitalis  has  been  found  valuable 
(Lancet,  ii.,  1871,  p.  705).  I  have  myself  seen  excellent  results  from  the 
last-mentioned  in  conjunction  with  bromides,  in  epilepsy  connected  with 
masturbation  or  nocturnal  emissions;  it  has  marked  control  over  such 
conditions. 

I  find  it  best  to  give  the  digitalis  separately,  morning  and  afternoon, 
and  the  bromide  at  night,  and  have  found  this  treatment  stop  the  onanism 
and  emissions,  and  cure  the  epilepsy.  The  infusion  of  digitalis  is  the 
best  preparation,  and  should  be  given  in  \  to  1  dr.  doses. 

Charcot  recommends  the  bromide  of  zinc  (British  Medical  Journal, 
ii.,  1877,  p.  132),  and  Bourneville  the  bromide  of  camphor  (i.,  1877).  I 


108  MATERIA    MEDICA    AND    THERAPEUTICS. 

have  frequently  tried  the  latter  compound,  but  have  never  seen  from  it 
results  which  could  not  be  better  obtained  from  other  bromides,  or  from 
camphor  separately.  Beigel  recorded  good  results  from  bromide  with 
morphia  hypodermically  (Medical  Times,  i.,  1869,  p.  G8),  but  morphia, 
when  given  internally  for  any  length  of  time,  acts  injuriously,  and  when 
subcutaneously  administered  for  a  similar  time  is  still  more  detrimental. 

I  am  satisfied,  from  careful  and  long-continued  observation,  that  opium 
does  not,  in  any  form  or  combination,  cure  epilepsy;  but  when  convulsive 
attacks  occur  as  complications  of  passing  mental  disease,  it  is  sometimes 
helpful,  either  alone  or  combined  with  bromides,  for  allaying  excitement 
and  convulsion  for  a  time,  and  procuring  sleep,  but  its  effects  are  tran- 
sient. 

The  proportion  of  cures  obtained  by  bromides  or  their  combinations — 
meaning  a  cessation  of  convulsive  attacks  for  from  six  months  to  four 
years  or  upwards,  according  to  the  period  that  cases  remained  under  ob- 
servation— has  been  stated  at  about  one-half  for  adults,  and  one-quarter 
for  children  (Voisin,  Legrand  du  Saulle);  and  even  if  absolute  cure  be 
not  obtained  quite  in  such  proportion,  it  is  so  sufficiently  often  to  prove 
its  possibility.  Probably,  however,  in  the  majority  of  cases,  freedom 
from  attack  will  be  contingent  upon  more  or  less  continued  use  of  the 
remedy.  In  cases  that  are  satisfactory,  we  see  nothing  of  an  effect  some- 
times mentioned  as  an  objection  to  the  use  of  bromides,  viz.,  a  greater 
violence  of  the  attacks  as  they  become  less  frequent.  It  is  true  that  this 
occurs  sometimes  during  the  natural  course  of  the  malady,  but  it  cannot 
be  directly  connected  with  the  medicine;  on  the  contrary,  this,  as  a  rule, 
diminishes  the  severity  as  well  as  the  frequency  of  the  convulsion. 

Binz  has  suggested  that  not  only  the  physiological,  but  also  the  ther- 
apeutical effect  of  the  bromide  of  potassium  is  due  to  the  latter  agent 
(potassium),  improving  the  blood- condition,  etc.  (Practitioner,  1874),  and 
Sanders  even  states  that  the  chloride  of  potassium  has  answered  equally 
well  in  his  hands  (  Centralblatt  fur  Medicin,  1868);  but,  while  we  agree 
that  some  of  the  depressant  effects  of  bromide  of  potassium  in  the  circu- 
lation might  be  explained  by  the  known  action  of  potash,  its  effects  on 
the  nervous  system  cannot  be  so,  and  the  result  of  Sequin's  observations 
showed  that  the  use  of  chloride  of  potassium  increased  the  attacks  in 
cases  which  bromide  relieved  in  the  proportion  of  80  per  cent.  (Medical 
Times,  i.,  1878).  The  nitrate  and  bicarbonate  of  potash  have  also  been 
proved  useless  (Anstie:  Practitioner,  1874). 

In  the  "Gulstonian  Lectures  for  1880,"  Dr.  Gowers,  stating  the  re- 
sults of  his  experience  in  the  treatment  of  epilepsy,  says  that  when  small 
doses  of  the  bromide  are  given  to  ward  off  regularly  recurring  attacks, 
they  should  be  taken  only  a  short  time — two  or  three  hours — before  the 
fits  are  expected;  that  they  will  fail  if  taken  at  longer  intervals  before. 
Larger  doses  may,  however,  be  taken  then.  He  has  met  with  many  cases 


,  BROMINE.  109 

in  which  he  has  noticed  a  cumulative  effect  of  the  drug,  but  many  others  in 
•which,  after  a  time,  a  tolerance  of  it,  or  indifference  to  it,  is  attained,  and 
an  increase  of  the  dose  becomes  necessary  to  obtain  the  customary  result. 
To  control  the  fits  the  bromide  must  be  given  frequently,  but  not  in  lar- 
ger doses  than  a  drachm  or  a  drachm  and  a  half  in  the  day;  but,  for  the 
cure  of  the  disease,  he  considers  it  necessary  to  keep  the  patient  for  a 
time  under  the  full  influence  of  the  drug,  by  giving  a  large  dose  every 
two  or  three  days — as  much  as  can  be  well  borne.  Gowers  has  given,  in 
this  way,  as  much  as  an  ounce  at  a  time,  but  adds  the  caution  not  to  be- 
gin with  a  larger  dose  than  half  that  quantity.  He  considers  that  only 
in  this  way  can  the  "stability  of  the  resistance  of  the  nerve-cells"  be  re- 
established. The  drugs  that  he  has  found  most  useful  in  combination  with 
bromide,  where  that  by.  itself  has  failed,  are  digitalis  (where  there  is  as- 
sociated cardiac  disturbance,  or  in  nocturnal  epilepsy),  belladonna,  can- 
nabis  indica  (when  between  the  attacks  there  is  persistent  headache), 
and  iron. 

Convulsion. — In  the  wide  range  of  convulsive  and  spasmodic  disor- 
ders, outside  that  which  we  distinguish  as  epilepsy,  bromides  are  very  effi- 
cacious. In  the  convulsions  occurring  during  pregnancy,  especially  from 
reflex  irritation  at  the  time  of  parturition,  they  are  more  distinctly  indica- 
ted than  in  the  albuminuric  form,  but  I  have  seen  them  also  relieve  the 
latter.  Peaslee  thought  them  valuable  only  during  the  threatening  stage, 
when  the  urine  is  scanty,  and  certainly,  the  earlier  the  patients  are  brought 
under  their  influence,  the  more  satisfactory  the  result.  In  urcemic  con- 
vulsion some  observers  have  objected  to  the  use  of  bromides,  but  they 
have  been  found  generally  of  some  assistance  in  lessening  the  paroxysm; 
eliminant  and  other  remedies  should  be  conjoined.  The  dose  in  such 
cases  should  be  large,  •£  dr.  every  hour  or  two.  When  swallowing  is  im- 
possible, they  act  well  given  in  enemata  (Gimbert  and  others:  Medical 
Times,  i.,  1872,  and  i.,  1874). 

Dentition. — In  the  restlessness  and  nerve-irritation  or  convulsion 
sometimes  attendant  on  dentition,  bromides  are  exceedingly  useful,  "  so 
that  the  gum-lancet  is  scarcely  ever  needed."  The  convulsions  even  of 
meningitis  I  have  frequently  seen  arrested  by  the  bromides. 

Tetanus — Strychnia-poisoning. — We  have  shown  reason  to  believe 
that  bromides  lessen  spinal  congestion  and  diminish  reflex  irritability 
(v.  p.  113),  and  this  being  so,  they  ought  to  prove  valuable  remedies  in 
the  disorders  named.  We  have  not  a  large  amount  of  clinical  experience 
on  this  point.  In  a  recent  collection  of  415  cases  of  tetanus,  by  Dr. 
Yandell,  bromide  does  not  seem  to  have  been  used  once  (Brain,  October, 
1878),  but  Dr.  H.  C.  Wood  has  tabulated  18  cases  of  tetanus  thus 
treated,  and  of  these  only  2  died;  in  one  of  them,  large  doses  of  bella- 
donna confused  the  result.  In  most  of  the  successful  cases,  chloral  or 
morphia  was  given  at  bedtime. 


110  MATEEIA   MEDICA    AND    THERAPEUTICS. 

Dr.  Southey  relates  a  successful  case,  in  which  conium  was  combined 
(Lancet,  \.,  1875).  Of  the  bromides,  full  doses — at  least  £  oz.  in  the 
twenty-four  hours — should  be  given. 

Saison  found  with  animals  that  hypodermic  injections  of  strychnia 
distinctly  modified  the  action  of  bromide,  and  vice  versa;  and  there  are  a 
few  instances  in  which  a  fatal  result  from  poisoning  was,  in  all  probabil- 
ity, prevented  by  bromide  treatment.  Thus,  Dr.  Gillespie  records  a  case 
in  which  nearly  3  gr.  of  the  alkaloid  were  taken,  and  very  serious  symp- 
toms developed;  but  recovery  took  place  under  the  influence  of  an 
ounce  of  bromide  given  in  divided  doses — no  vomiting  occurred  (Ameri- 
can Journal,  October,  1870).  In  Dr.  Hewlet's  case  more  than  4  gr.  of 
strychnia  were  taken,  and  although  vomiting  had  occurred  and  opium 
been  given,  severe  convulsions  had  set  in;  90  gr.  *f  bromide  were  admin- 
istered, at  first  every  half-hour,  and  afterward  60  gr.  every  hour,  and 
twenty-six  hours  after  the  first  dose  the  patient  could  walk  (British  and 
Foreign  Review,  July,  1871).  Another  case  of  recovery  after  a3-gr.  dose 
of  the  poison,  and  similar  treatment,  is  given  by  Dr.  Bard  (Philadelphia 
Medical  Times,  June,  1871;  Record,  1879). 

Migraine,  Congestive  Headache,  etc. — If  given  in  the  prodromal 
stage  of  an  attack  of  migraine,  the  bromides  often  succeed  in  preventing 
its  development,  and  especially  when  the  head-pain  and  the  nerve-disturb- 
ance precede,  or  are  more  prominent  than  the  nausea  or  gastric  disorder 
(Yandell,  Latham).  Five  grains  every  hour  or  half-hour  may  be  given, 
but  if  an  attack  has  already  set  in,  a  full  dose  of  20  to  30  gr.  is  better, 
and  if  this  produces  sleep,  the  patient  usually  wakes  free  from  headache. 
After  the  paroxysm  has  fully  set  in,  the  remedy  does  not  seem  to  con- 
trol it  (Medical  Times,  i.,  1875,  p.  338). 

In  ordinary  congestive  headache,  with  flushed  face,  and  intolerance 
of  light  and  noise,  and  in  congestive  neuralgia  generally,  the  bromides 
are  serviceable;  also  in  the  headache  occurring  in  delicate  children  from 
even  moderate  application  to  study.  Dr.  Day  recommends  their  use 
with  iodides  for  children  who  suffer  from  constant  headache  and  debility 
(Lancet,  i.,  1875,  p.  854);  but  I  have  been  disappointed  with  this  combina- 
tion under  such  circumstances. 

Chorea. — The  varying  results  obtained  in  the  treatment  of  chorea 
must  be  connected  with  its  varying  pathology,  which  is  not  yet  well 
understood.  I  have  seen  a  few  patients  recover  rapidly  under  treatment 
by  bromide,  but  the  majority  are  too  anaemic  or  asthenic  to  bear  it  well; 
hence,  it  is  not  surprising  that  Dr.  R.  Reynolds  found  it  even  prejudicial 
in  some  cases. 

Dr.  Ramskill  tried  fully  the  potassium  salt,  "  and  with  strong  preju- 
dice in  its  favor,"  but  without  satisfactory  result.  Camphor  bromide  is 
said  to  have  acted  better  (British  Medical  Journal,  i.,  1877),  but  has  not 
done  so  in  my  experience. 


BEOMINE.  Ill 

Hysteria. — In  ordinary  cases  of  hysteria,  bromides  alone  do  not  give 
the  relief  that  might  be  expected.  The  convulsive  epileptiform  seizures 
which  sometimes  occur  may  be  controlled  by  them  when  the  patients  are 
fairly  strong,  but  mere  emotional  disturbance  and  nerve-debility  are 
better  treated  by  other  remedies.  The  malady  is  essentially  connected 
with  enfeebled  nerve-power.  Gubler,  indeed,  compares  its  paroxysms 
to  convulsions  after  hemorrhage,  and  in  such  cases  bromides  are  not 
really  curative.  In  combination,  e.g.,  with  iron,  valerian,  or  camphor, 
they  may  be  of  more  service. 

Uterine  Irritation. — If  hysterical  symptoms  be  definitely  connected 
with  ovarian  irritation  or  uterine  congestion,  then  the  bromides  are  more 
distinctly  indicated.  In  the  distressing  condition  of  unrest,  undue  appre- 
hension and  depression,  which  often  occurs  at  the  climacteric  period, 
they  may  prove  of  the  greatest  service,  quieting  the  restlessness,  and  re- 
lieving the  sense  of  fulness  in  the  head  and  flushing  of  the  face.  Dr. 
Ringer  found  them  to  exert  a  favorable  influence  over  the  apprehensive 
and  desponding  thoughts  which  arise  sometimes  in  the  later  periods  of 
pregnancy  (Lancet,  L,  1869),  and  they  have  relieved  even  the  sensations 
and  symptoms  of  a  "spurious  pregnancy"  occurring  at  the  climacteric 
period  (Simpson:  Medical  Times,  ii.,  1859). 

Spasmodic  Disorders — Laryngismus. — The  bromides,  but  especially 
the  bromide  of  ammonium,  will  be  found  very  useful  in  relieving  the 
laryngeal  spasm  of  this  disease;  but  its  usual  connection  with  rachitis 
must  not  be  overlooked,  and  tonic  treatment,  good  hygiene,  and  improved 
nutrition  must  be  combined  for  a  satisfactory  result. 

Pertussis. — Dr.  Gibb  was  one  of  the  first  to  ascertain  the  value  of 
bromides  in  this  disorder,  and  he  found  the  ammonium  salt  to  act  best; 
it  quickly  relieved  the  whoop,  i.e.,  the  laryngeal  spasm.  Dr.  G.  Harley 
also  early  recorded  satisfactory  cases  (Lancet,  i.  and  ii.,  1863).  I  have 
often  verified  this  use  of  the  bromides,  especially  in  early  stages.  I  order 
for  children  3  to  5  gr.  every  two  to  four  hours,  as  a  rule  not  giving  more 
than  20  gr.  in  the  day,  because  of  the  depression  induced  in  weakly  sub- 
jects; I  often  combine  belladonna,  and  sometimes  chloral,  with  the  treat- 
ment. Dr.  Ringer  reports  them  as  useful  only  in  simple,  uncomplicated 
cases,  but  neither  dentition  nor  a  pyrexial  state  need  prevent  their  use  if 
the  spasm  continue;  they  are  fairly  presumed  to  lessen  congestion  in  the 
medulla  as  well  as  in  the  mucous  membrane  of  the  fauces,  and  to  diminish 
reflex  excitability. 

If  catarrh  be  present,  an  expectorant  may  be  conjoined,  and  if  bron- 
chitis or  pneumonia  supervene,  the  spasm  generally  subsides  for  a  time, 
and  a  different  treatment  is  indicated.  The  convulsion  of  pertussis  I  have 
frequently  seen  relieved  by  bromide,  but  belladonna  is  much  more  service- 
able. 

Dysphagia. — There  is  a  peculiar  form   of   difficulty   in   swallowing 


112  MATERIA    MEDIC  A   AND    THERAPEUTICS. 

liquids,  which  I  have,  seen  only  in  children;  they  drink  readily,  but  the 
fluid  either  returns  at  once  from  the  mouth  or  partly  chokes  them,  or  they 
remain,  with  open  mouth,  gradually  swallowing  small  quantities  with  con- 
tinued muscular  spasm.  No  definite  cause  can  be  assigned.  The  symp- 
toms come  on  a  few  months  after  birth,  and  I  have  seen  it  mostly  among 
the  children  of  the  poor.  It  may  be  relieved  by  bromide,  and  Dr.  Ringer 
has  remarked  that  a  similar  condition,  when  congenital,  is  much  benefited 
by  bromide  of  potassium. 

The  dysphagia  of  phthisis,  connected  with  local  irritation  and  inflam- 
mation, is  also  relieved  by  the  salt,  which  should  be  swallowed  slowly  and 
well  diluted  with  mucilage. 

Colic. — In  cases  of  cramping  pain  in  the  stomach  or  intestine,  such  as 
occurs  more  frequently  in  children,  and  is  independent  of  diarrho3a,  but 
connected  with  irregular  muscular  contraction,  the  bromides  usually  re- 
lieve better  than  other  remedies. 

Spasm  of  Rectum  and  Bladder. — In  cases  of  tenesmus,  whether  of  the 
bladder  or  rectum,  bromides  will  often  be  found  useful.  Hammond 
recommends  bromide  of  camphor  (British  Medical  Journal,  i.,  1877),  and 
£-dr.  doses  of  bromide  of  potassium  have  given  relief  to  a  severe  case  of 
rectal  spasm  when  opium,  belladonna,  and  instrumental  interference  all 
had  failed  (Lancet,  ii.,  1873,  p.  45G). 

Enuresis. — In  the  simple  enuresis  of  children,  bromides  may  usually  be 
relied  upon.  The  good  derived  from  them  is  probably  due  to  "  increas- 
ing the  stability  of  resistance  of  the  cells  in  the  lower  part  of  the  spinal 
cord  "  (Gowers). 

Spasmodic  Asthma. — There  are  certain  cases  in  which  very  striking 
results  may  be  obtained  from  the  bromides:  e.g.,  a  man,  aged  thirty,  sub- 
ject to  attacks  since  infancy,  suffered  about  once  in  the  week  from  even- 
ing till  two  or  three  o'clock  the  following  morning,  but,  after  a  fortnight's 
treatment  with  full  doses  of  bromide  taken  at  night,  he  had  no  further 
attacks  (Saison).  As  a  rule,  it  will  be  found  that  this  remedy  does  not 
act  so  well  as  an  "antispasmodic"  during  the  paroxysm,  but  better  if 
given  during  the  interval,  apparently  by  exerting  a  sedative  influence  on 
the  central  nervous  system. 

Dr.  Begbie  found  it  very  successful  in  two  cases  (Edinburgh  Medical 
Journal,  1866),  and  G.  See  reported  that  though  the  catarrhal  element 
in  the  malady  was  not  modified,  the  access  of  paroxysms  was  delayed,  and 
the  dyspnoea  lessened  or  quite  controlled  (Bulletin,  1865).  I  can  recom- 
mend the  bromide  in  chronic  cases  of  asthma,  and  especially  when  there  is 
excentric  irritation,  as  of  the  pelvic  organs;  it  is  sometimes  well  combined 
with  iodide. 

Angina  Pectoris — Palpitation. — The  bromide  is  sometimes  of  service 
in  severe  breast-pang.  Thus,  Papillaud  relieved  severe  paroxysmal  at- 
tacks by  the  use  of  £  to  2  dr.  doses  continued  "  at  intervals  "  for  two  or 


BROMINE.  113 

three  months.  In  nervous  palpitation  it  is  often  a  very  good  remedy, 
and  I  have  known  it  especially  relieve  gouty  patients.  Berger  found 
bromide  of  camphor  to  answer  well. 

Vagus  Irritation. — Dr.  Somerville  has  related  a  remarkable  case  in 
which  a  very  slow  pulse  of  fifteen  to  twenty  per  minute  was  found  on 
one  occasion  after  an  error  in  diet,  and  seemed,  therefore,  connected  with 
irritation  of  the  gastric  terminals  of  the  vagus;  the  slowing  was  suc- 
ceeded by  quick,  tumultuous  heart-action,  and  during  this  stage  marked 
benefit  was  derived  from  bromide  (Practitioner,  March,  1876).  It  was, 
however,  given  with  belladonna. 

Undue  Reflex  Action,  Vomiting,  etc. — In  a  number  of  cases,  somewhat 
dissimilar  in  symptoms,  but  connected  with  exaggerated  reflex  action, 
whether  spasmodic  in  character  or  exhibiting  altered  function  or  secre- 
tion, the  bromides  prove  useful.  In  reflex  vomiting,  as  that  of  pregnancy, 
or  even  in  sea-sickness,  and  sometimes  in  cerebral  vomiting,  they  give 
relief.  Five  to  ten  grain  doses,  if  retained,  are  often  sufficient;  but,  in 
obstinate  cases  connected  with  pregnancy,  ^  to  2  dr.  doses  have  been 
successfully  given  by  injection  (Lancet,  i.,  1874,,  p.  770).  Laborde  has 
seen  it  useful  in  the  vomiting  of  various  gastro-intestinal  disorders. 

Diarrhoza. — When  this  is  reflex  in  character,  as  it  often  is  during 
dentition,  or  when  associated  with  a  congested  relaxed  state  of  intestinal 
mucous  membrane,  bromides  may  prove  the  best  remedies. 

Cholera. — It  is  not  going  beyond  our  knowledge  to  state  that  capil- 
lary spasm  and  congestion  of  vaso-motor  centres  are  essential  elements 
in  the  phenomena  of  cholera,  and  it  would  not,  d priori,  seem  unreason- 
able to  expect  benefit  from  bromides;  there  is  certainly  some  clinical 
evidence  of  it.  Thus,  Dr.  James  Begbie,  giving  ^-dr.  doses  of  the  potas- 
sium salt,  noticed  that  capillary  circulation  was  quickly  re-established,  as 
shown  by  the  return  of  color  to  the  limbs,  and  the  recurrence  of  urinary 
secretion  that  had  ceased:  he  considered  the  remedy  a  valuable  one  (Edin- 
burgh Medical  Journal,  and  Lancet,  ii.,  1866).  Dr.  Henry  Sutton  has 
also  published  cases  of  recovery  under  its  use  (Medical  Times,  ii.,  1867). 

Menorrhagia — Leucorrhoea. — Bromides  often  act  very  well  in  reliev- 
ing both  of  these  discharges,  but  especially  the  former  when  dependent 
on  congestion. 

Spermatorrhoea,  etc. — In  irritation  of  the  male  genitals  in  plethoric 
subjects,  with  undue  erections  or  excessive  seminal  losses,  the  bromides 
are  often  highly  useful.  They  have  a  local  anaesthetic  effect  when  ap- 
plied to  the  urethra,  and  when  taken  internally  their  value  is  evident 
rather  in  cases  when  sexual  excitement  is  connected  with  local  irritation 
and  congestion,  as  haemorrhoids,  ascarides,  etc.,  than  when  there  is  mental 
or  central  causation.  They  tend  to  lessen,  also,  spinal  congestion  and 
reflex  irritation.  Berger  finds,  perhaps,  the  best  results  from  camphor 
bromide  in  such  cases  (Medical  Times,  i.,  1877;  p.  264).  When  there  is 
VOL.  L— 8 


114  MATERIA    MEDICA    AND   THERAPEUTICS. 

marked  debility  with  anaemia,  or  when  spermatorrhoea  is  unaccompanied 
by  erections  or  sensations,  bromides  are  not  the  best  remedies. 

Cystitis — Urethritis. — Saison  has  seen  the  bromides  give  great  relief 
in  these  cases.  They  should  be  used  both  locally  and  internally. 

Disorders  of  Sympathetic  Nerve. — A  number  of  anomalous  symptoms 
which  may  be  referred  to  this  cause  are  relieved  by  bromides;  for  instance, 
"sudden  numbness,  coldness,  deadness,  or  pricking  sensations  in  one  or 
more  limbs;  distressing,  indefinable  feelings  in  the  epigastrium  or  ab- 
domen; or  sensations  akin  to  rigor,  with  much  anxiety  and  palpitation 
or  'fluttering'  of  the  heart."  In  such  cases  the  local  circulation  may  be 
interfered  with,  the  pulse  in  one  arm  becoming  irregular  and  faltering, 
while  in  the  other  it  may  remain  unaltered,  and  the  heart-beats  continue 
normal. 

Urticaria. — In  the  capillary  congestion  of  this  malady,  which  is  con- 
nected with  irregular  action  or  paresis  of  vaso-motor  nerves,  the  bromides 
are  indicated.  Thus,  Dr.  Andrews  reports  the  cure  of  a  chronic  recur- 
rent case  under  their  use  (Lancet,  i.,  1870,  p.  402). 

Exophthalmic  Goitre. — According  to  Dr.  Brown  (U.  S.)  and  others, 
the  bromides  have  proved  useful  in  this  malady  (British  and  Foreign 
.Review,  i.,  1868),  and  I  think  benefit  may  usually  be  expected  from  them, 
especially  when  combined  with  quinine. 

Phthisis  Pulmonalis. — There  are  certain  distressing  phthisical  symp- 
toms which  are  amenable  to  the  influence  of  bromides  on  vaso-inotor 
nerves  and  reflex  action.  Thus,  a  hacking,  laryngeal  cough,  or  reflex 
vomiting,  or  even  pyrexia,  may  be  relieved;  also  the  difficulty  and  pain  in 
deglutition  connected  with  pharyngeal  irritation.  Profuse  sweating  and 
eren  flux  from  the  bowels  may  be  controlled  by  the  bromides — especially 
by  bromide  of  calcium — though  usually  the  anaemic  and  depressed  condi- 
tion may  be  met  better  by  acids  or  mineral  astringents. 

Insomnia  is  but  a  symptom,  and  one  produced  by  various  and  often 
opposite  pathological  conditions.  We  accordingly  find  that  the  different 
hypnotics  cannot  be  used  with  equal  success  in  all  cases  presenting  this 
one  symptom  in  common,  and  so,  while  bromides  are  of  most  signal  value 
in  some  conditions,  they  are  useless  or  even  harmful  in  others.  This  may 
be  explained  partly  by  varying  conditions  of  the  blood-supply,  partly  by 
difference  in  the  states  of  nutrition  of  the  nerve-cells.  It  is  when  there 
is  moderate  cerebral  hypercemia,  such  as  probably  exists  after  prolonged 
mental  effort — whether  associated  with  study,  with  excitement,  or  anxi- 
ety— and  when  unrest  and  sleeplessness  are  marked  symptoms,  that  the 
bromides  are  far  more  soothing  and  more  curative  than  opium;  and  even 
if  inflammatory  action  be  present,  they  may  still  be  very  serviceable,  in 
conjunction  with  aconite,  ice,  or  other  remedies. 

If  there  be  much  cerebral  anaemia,  it  may  even  be  increased  by  the 
remedy,  and  I  have  seen,  in  debilitated  hypochondriacs,  and  in  some 


BROMINE.  115 

aged  people,  aggravation  of  the  symptoms  with  marked  increase  of  the 
prostration.  In  some  cases  of  senile  insomnia,  I  have,  however,  found  it 
very  useful  given  with  the  last  meal,  in  doses  of  10  to  20  gr.  or  more,  dis- 
solved in  milk,  tea,  soup,  beer,  or  cold  water.  In  the  sleeplessness  of 
convalescence  from  acute  disease  and  of  dyspepsia,  bromide  is  useful, 
combined  in  the  latter  case  with  dietetic  and  other  special  treatment. 
In  pregnancy,  where  pain  is  suffered  and  prevents  sleep,  a  combination 
of  chloral  and  bromide — 15  gr.  of  each — is  especially  useful.  In  weakly 
subjects,  and  especially  in  the  insane  or  hypochondriacal,  bromide  is  best 
given  in  combination  with  cannabis  indica.  When  insomnia  is  induced 
by  severe  pain,  opium  is  the  best  remedy;  but  its  effect  is  heightened, 
and  its  tendency  to  produce  headache,  faintness,  and  nausea  lessened,  by 
bromide.  Da  Costa  recommends  the  latter  to  be  given  in  full  doses  half 
an  hour  before,  and  two  hours  after,  the  opium. 

To  choose  a  suitable  quantity  is  of  importance;  it  is  usually  from  20 
to  30  gr. 

Wolfe  relates  a  case  of  insomnia  with  hypochondriasis  and  irritability, 
from  over-anxiety,  when  5  gr.  proved  useless,  but  %  dr.  "  acted  like  a 
charm."  Behrend  relates  two  very  good  illustrations  of  nervous  excite- 
ment and  anxiety,  with  loss  of  sleep,  in  which  25  gr.,  at  first  thrice  daily, 
afterward  less  often,  proved  quickly  curative  (Lancet,  i.,  1866;  ii.,  1864, 
p.  1).  In  the  sleeplessness  and  delirium  of  fevers,  the  bromides  exert  a 
favorable  influence  in  procuring  sleep,  and  they  prove  a  valuable  resource 
when  opium  is  not  admissible. 

I  have  sometimes  found  bromide  of  camphor,  in  3  to  5  gr.  doses,  pro- 
cure sleep  for  hysterical  subjects,  and  Deboul  recommends  it  in  the  un- 
rest of  cardiac  disease,  and  of  phthisis  (British  and  Foreign  Review,  i., 
1865).  The  solid  capsule  of  Clin  is  liable  to  cause  gastric  irritation,  and 
is  better  given  dissolved  in  milk. 

Delirium  Tremens. — For  the  excitement,  wakefulness,  fright,  and 
tremor  which  follow  the  abuse  of  alcohol,  and  which  commonly  precede 
a  fully  developed  attack  of  delirium,  large  doses  of  bromide  often  prove 
of  great  use,  either  with  or  without  opium.  I  have  known  them  prevent 
the  further  development  of  the  attack;  in  later  stages  they  have  not  the 
same  power,  but  bromides  have  acted  well  combined  with  chloral.  To 
this  statement  I  must,  however,  add  a  caution  as  to  the  use  of  full  doses 
of  the  latter  remedy  in  delirium  tremens,  for  I  am  cognizant  of  more 
than  one  case  of  sudden  death  traceable  to  it,  in  all  probability. 

Gubler  has  written  specially  on  the  value  of  bromides  in  amblyopia 
and  alcoholic  amaurosis. 

Night-terrors — "  Nightmare" — Children  especially  are  liable  to  at- 
tacks of  terror  in  the  night,  when  they  awake  screaming,  and  are  so  deep- 
ly impressed  by  some  imagination  or  dream,  that  they  are,  at  first,  scarce- 
ly conscious.  This  condition  is  connected  with  a  reflex  irritation  of  the 


116  MATERIA    JIEDICA   AND   THERAPEUTICS. 

nervous  system,  and  is  much  under  the  control  of  a  night-dose  of  bromide. 
The  nightmare  of  adults  may  also  be  relieved  by  it;  aperients  should  not 
be  neglected  in  such  cases. 

Mania. — The  use  of  bromides  in  insane  patients  requires  special  study 
and  care,  because  of  their  liability  to  be  suddenly  depressed,  and  the 
prostration  I  have  sometimes  seen  well  illustrates  the  clinical  fact  that 
an  enfeebled,  ill-nourished  nervous  system  often  centra-indicates  these 
medicines,  even  if  the  general  bodily  health  seems  to  be  fair. 

Dr.  S.  W.  D.  Williams  records  that,  of  thrity-seven  insane  epileptics 
treated  by  bromides,  the  fits  were  relieved  in  most,  but  great  depression 
occurred  in  some  of  them  without  any  relief  to  their  attacks;  £-dr.  doses 
proved  too  large;  catharsis  was  caused  in  two  cases,  and  possibly  the  rapid 
development  of  phthisis  in  a  third  (Medical  Times,  ii.,  1864,  p.  88). 

Mr.  Wood  (Durham)  has  also  recorded  instances  among  insane  patients 
of  "  sudden  development  of  severe  prostration  and  despondency  (British 
Medical  Journal,  ii.,  1871);  vomiting  and  abdominal  pain  were  also  caused. 

Dr.  Clouston,  in  a  careful  study  of  the  effects  of  different  medicines 
upon  the  nerve-condition  of  lunatics,  found  that  the  bromides,  if  given 
alone,  needed  to  be  used  in  very  large  doses  for  the  subduing  of  violent 
paroxysms.  One  female  patient  took  7  oz.  in  divided  doses,  but  then 
suddenly  lapsed  into  a  condition  of  extreme  "  torpid  depression,"  not  free 
from  danger  to  life,  and  continuing  many  days.  The  same  physician 
ascertained  that  a  combination  with  cannabis  indica  gave,  even  in  small 
doses,  much  better  results  than  either  remedy  alone,  £  dr.  of  each  given 
together  acting  as  a  hypnotic  better  than  1  dr.  of  tincture  of  cannabis 
indica,  or  2  dr.  of  bromide  ( Medico-  Chirurgical  Review,  ii.,  1870,  and 
1871). 

Puerperal  Mania. — In  acute  stages  of  excitement  and  delirium  con- 
nected with  the  puerperal  state,  bromides  act  well,  and  should  always  be 
given.  They  have,  doubtless,  an  influence  over  the  uterine  and  ovarian 
congestion  of  that  state,  and  over  reflex  irritability,  and  many  successful 
cases  of  use  are  on  record.  Curgenven  has  found  the  potassium  salt  act 
quickly  and  well  when  given  by  the  rectum.  I  have  often  given  it  alter- 
nately with  aconite,  with  much  advantage. 

Erotomania — Nymphomania. — When  these  conditions  occur  in  con- 
nection with  a  generally  demented  state,  the  bromides  do  not  seem  to  re- 
lieve so  much  as  might  have  been  expected.  My  friend,  Dr.  Mackey, 
when  in  charge  of  a  large  asylum  at  the  time  when  bromides  were  first 
introduced,  and  were  specially  recommended  in  sexual  cases,  gave  the 
potassium  salt  to  many  of  the  younger  patients,  especially  youths  addicted 
to  masturbation,  but  generally  with  the  result  of  inducing  extreme  and 
miserable  depression,  without  controlling  the  symptoms.  Dr.  Williams 
also  noted  that  in  his  thirty-seven  insane  cases  the  sexual  system  was  not 
at  all,  or  but  slightly  affected.  Even  in  subjects  of  average  mental  health, 


BROMINE.  117 

but  addicted  to  onanism,  the  bromides,  though  they  lessened  the  venereal 
appetite  for  a  time,  effected  no  cure  in  Dr.  Bill's  experience,  and  he  con- 
cluded that  they  could  lessen  only  excentric  sexual  irritation  (American 
Journal,  July,  1868).  In  this  they  certainly  are  highly  valuable.  In  the 
few  cases  that  I  have  seen  approaching  to  nymphomania,  benefit  was  de- 
rived from  the  bromides  alone,  but  they  act  best  when  given  in  conjunc- 
tion with  bath,  counter-irritation,  and  moral  agencies.  Dr.  E.  C.  Clarke 
and  Dr.  Begbie  have  recorded  very  satisfactory  results. 

Cerebral  Apoplexy. — There  is  reason  to  hope  for  advantage  from  the 
use  of  bromides  in  the  symptoms  of  cerebral  congestion  which  point  to 
an  apoplectic  tendency.  Dr.  Bastian  has  remarked  that,  in  such  cases, 
when  the  heart-action  is  forcible  and  frequent,  these  remedies,  conjoined 
with  aconite,  are  very  suitable,  and  I  quite  concur  in  this  statement 
(Lancet,  ii.,  1874,  p.  897). 

Meningitis — Hydrocephalus. — I  have  seen  the  convulsions  of  trau- 
matic meningitis  arrested  under  bromide  of  potassium,  and  it  is  said  that 
recovery  from  tubercular  meningitis  (acute  hydrocephalus)  has  followed 
its  use.  In  support  of  this  statement  Dr.  John  Brunton  has  recorded 
four  cases  (Glasgow  Medical  Journal,  1873),  in  which  the  heads  were 
enlarged,  and  the  symptoms  were  certainly  serious,  but  there  were  no 
convulsions,  and  the  diagnosis  must  be  held  rather  doubtful  (cf.  pp.  87, 
88). 

Spinal  Congestion — Cerebro-spinal  Meningitis. — In  spinal  conges- 
tion of  acute  character,  with  pain,  hypersesthesia,  cramp,  and  spasm,  the 
bromides  have  proved  so  far  useful  as  to  merit  always  a  fair  trial. 

In  true  cerebro-spinal  meningitis — though  a  very  fatal  disease  under 
any  treatment — I  have  seen  great  advantage  from  bromides,  but  like  all 
depressant  remedies  they  must  be  used  with  caution,  for  there  is  liability 
to  sudden  failure  of  the  circulation  from  conditions  of  the  disease  itself. 
Subject  to  the  same  caution,  I  think  it  desirable  to  conjoin  aconite  or 
belladonna  throughout  the  treatment. 

Diphtheria. — The  bromides  have  proved  valuable  in  this  disorder, 
both  when  taken  internally  and  when  applied  to  the  inflamed  parts.  Dr. 
Caro  uses  a  spray  containing  1  dr.  to  the  ounce,  and  finds  it  lessen  capil- 
lary congestion,  and  when  the  cough  is  dry  it  aids  the  expectoration  of 
membrane  (Medical  Times,  i.,  1874,  and  i.,  1876,  p.  588).  Dr.  Post  recom- 
mends a  solution  of  the  same  strength  with  20  min.  of  bromine,  and  gives 
10  drops  every  hour  to  a  child  of  three  years/ 

Rheumatism. — The  bromide  of  ammonium  has  been  found  extremely 
useful  in  acute  rheumatism  by  Da  Costa  (American  Journal,  April, 
1871).  Gueneau  de  Mussy  also  praises  the  bromide  for  the  same  malady. 
For  subacute  cases,  for  rheumatic  gout,  and  for  the  resulting  stiffness 
and  nodosity  of  joints,  the  bromide  of  lithium  is  recommended  (Bartho- 
low).  This  remedy  is  certainly  valuable  for  relieving  the  wakefulness 


118  MATERIA    MEDICA    AND    THERAPEUTICS. 

and  delirium  of  rheumatic  fever;  morphia  may  occasionally  be  well  com- 
bined with  it. 

Bronchocele — Splenic  and  Glandular  Enlargements. — The  great  value 
of  bromides  in  nerve-disorder  has  led  us,  perhaps,  to  think  less  of  them  as 
remedies  in  scrofulosis  and  glandular  enlargements,  but  they  are  often 
very  useful  in  such  conditions.  Dr.  Wilks  recorded  their  good  effect  in 
bronchocele  (Medical  Times,  ii.,  1861,  p.  635),  and  I  have  used  them  fre- 
quently and  successfully  in  gland-swellings  connected  with  struma.  They 
have  been  by  others  recommended  in  combination  with  liquor  potasses 
(Lancet,  i.,  J860,  p.  62).  The  bromo-iodine  waters  of  Kreuznach  and 
Woodhall  Spa  are  also  good  forms  for  their  administration. 

Dr.  Robert  Williams  found  the  bromide  of  potassium  extremely  use- 
ful in  reducing  enlargement  of  the  spleen  (malarial),  and,  in  an  appendix 
to  his  classic  work  on  Morbid  Poisons,  gives  several  striking  instances  of 
its  value  when  other  and  better  known  medicines  had  failed. 

Mr.  Spencer  Wells  has  confirmed  the  observations  of  Dr.  Williams, 
and,  amongst  other  cases,  has  recorded  that  of  a  child,  aged  eight,  ex- 
tremely emaciated,  suffering  from  hectic,  and  with  the  abdomen  dis- 
tended by  an  enormously  large  spleen,  the  lower  edge  of  which  extended 
to  the  pubes.  The  case  seemed  apparently  beyond  the  power  of  medi- 
cine, but  yet,  under  the  influence  of  3  gr.  of  bromide  thrice  daily,  some 
diminution  was  produced  within  a  week;  under  5  gr.  this  continued, 
until  at  the  end  of  a  few  weeks  the  viscus  was  above  the  umbilicus,  and 
the  child  convalescent.  The  case  was  either  connected  with  ague  or  with 
blood-poisoning  from  unhealthy  atmosphere,  and  is  a  very  remarkable 
one.  Acting  on  the  suggestion  of  Mr.  Spencer  Wells,  I  have  myself 
used  the  drug  in  similar  cases,  but  in  larger  doses,  and  have  been  pleased 
with  it.  Claude  Bernard  has  recorded  equally  good  results,  but  with 
doses  of  20  to  40  gr.  daily  (Bulletin,  1874). 

Enlarged  Tonsils. — Saison  has  seen  the  bromides  of  service  in  this 
condition,  and  in  the  recurrent  angina  connected  with  it. 

Fibroid  Tumors. — The  power  which  bromides  possess  of  stimulating 
absorption  led  to  their  use  in  cases  of  uterine  fibroid,  and  Simpson 
recorded  successful  results  (Medical  Times,  ii.,  1859,  p.  599),  also  Graily 
Hewitt  (Medical  Times,  i.,  1861). 

The  Kreuznach  waters,  which  contain  bromides  and  iodides,  have  long 
enjoyed  a  special  reputation  in  such  cases;  but,  if  we  are  to  'judge  by  a 
discussion  of  some  years  ago,  many  eminent  authorities  in  London  have 
seen  little  or  no  advantage  from  them  (Medical  Times,  i.,  1857).  My  own 
experience,  however,  and  personal  observations  made  at  Kreuznach, 
have  satisfied  me  that  a  course  of  these  waters  does  often  diminish  the 
congestion  and  the  fibroid  growths,  although  their  good  effects  probably 
are  not  wholly  due  to  their  containing  bromides  and  iodides.  In  many 
of  my  cases  the  waters  have  also  removed  or  reduced  dense  infiltrated 


BROMINE.  119 

deposits  around  the  growths,  and  have  given  much  relief  and  comfort  to 
the  patient  (v.  p.  166). 

Ovarian  Tumor. — The  Kreuznach  waters  acted  so  favorably  upon 
several  of  my  patients  with  unilocular  ovarian  cysts,  that  I  now  always 
recommend  one  or  two  courses  of  them  before  advising  an  operation. 
Bromides  given  in  5  to  20-gr.  doses  two  or  three  times  daily,  and  con- 
tinued for  months,  frequently  diminish  the  size  of  the  cyst,  and  improve 
the  general  health.  The  dose  should  be  varied  from  time  to  time,  ac- 
cording to  circumstances. 

ABSORPTIVE  EFFECTS  OF  BROMIDES. — There  are  other  growths  and 
deposits  in  which  these  effects  have  been  utilized  by  different  observers, 
but  not  extensively.  Dr.  Wilks  observed  benefit  from  the  bromide  of 
potassium  in  cases  of  cephalalgia  dependent  on  thickened  membrane  or 
thickened  bone  (Lancet,  i.,  1870,  p.  191);  Dr.  Brown,  in  acute  and  chronic 
inflammation  of  testes  and  chronic  inflammatory  enlargements  (British 
and  Foreign  Review,  i.,  1868) ;  and  Dr.  Bird  states  that  from  ample  ex- 
perience in  Australia,  where  hydatids  are  common,  the  continued  admin- 
istration of  bromides  has  the  power  of  destroying  the  parasites,  and  caus- 
ing absorption  of  the  cysts  (Medical  Times,  ii.,  1873,  p.  164).  (For  a 
similar  effect  of  iodide,  v.  p.  87.) 

PREPARATION  AND  DOSE. — Potassii  Bromidum :  dose,  5  to  20  gr.  and 
,  upwards  (v.  pp.  106,  107,  109).  Ammonii  Bromidum :  dose,  2  to  20  gr. 
and  upwards. 

Concerning  the  different  bromides,  we  may  here  briefly  state  that 
the  potassium  salt  is  in  the  most  common  use,  but  contains  the  least  bro- 
mide of  the  alkaline  salts  (v.  pp.  97,  98),  and  is  more  depressing  to  the 
circulation. 

The  sodium  salt  I  consider  rather  more  powerful  as  a  bromide,  though 
all  observers  are  not  agreed  on  this  point.  It  is  less  depressing,  and  is 
more  easily  assimilated  (Clymer:  Medical  Times,  i.,  1872,  p.  238). 

The  ammonium  salt  possesses  some  of  the  stimulant  characters  of  its 
base,  which  is  liberated  by  decomposition.  Its  action  is  said  to  be  more 
rapid,  but  also  more  evanescent  (Begbie).  The  lithium  salt  has  been 
found  to  relieve  some  epileptics  better,  and  in  smaller  doses  than  the 
potassium  salt,  and  to  give  sleep  well  (Gibb,  1864;  Weir  Mitchell: 
American  Journal,  ii.,  1870).  The  calcium  salt  is  said  to  be  more  active 
than  that  of  potassium,  22  gr.  of  the  former  causing  sleep  when  the  latter 
failed  (Hammond).  The  compound  with  camphor  (monobromated  cam- 
phor) reduces  heart-acnon  and  lowers  respiration  and  temperature  like  the 
other  alkaline  bromides;  it  is  efficient  as  a  sedative  in  less  dose — 3  to  6 
gr.  In  the  compounds  with  morphia  and  quinine,  Dr.  Richardson  ex- 
pects to  secure  the  sedative  and  tonic  effects  of  these  drugs  without  the 
unpleasant  cerebral  symptoms  which  sometimes  accompany  them  (Medical 
Times,  i.,  1871,  p.  413).  I  have  found  them  useful.  Bromhydric  acid 


120  MATERIA    MEDICA    AND    THEKAPEUTICS. 

is  said  to  produce  most  of  the  good  effects  of  alkaline  bromides  with  less 
depression,  and  to  be  more  readily  borne  (C.  Wade,  M.  Fothergill).  Its 
real  value  is,  however,  not  yet  proved. 


CHLORUM—  CHLOKINE,  Cl=35-5. 

Chlorine,  discovered  by  Scheele  in  1774,  is  a  greenish  gas,  irrespirable, 
and  when  incautiously  inhaled  producing  injurious  irritant  effects.  It  has 
a  peculiar  odor;  is  very  soluble  in  cold  water;  it  bleaches  all  vegetable 
colors,  and  is  a  powerful  disinfectant;  under  a  pressure  of  six  atmos- 
pheres at  32°  F.  the  gas  becomes  a  yellow  liquid  of  sp.  gr.  1.33.  It  may 
be  prepared  from  any  metallic  chloride  (as  common  salt),  but  is  directed 
by  the  Pharmacopoeia  to  be  made  from  hydrochloric  acid  by  the  agency 
of  manganese  oxide,  the  oxygen  of  which  combines  with  the  hydrogen  of 
the  acid,  and  sets  free  chlorine  on  the  application  of  heat:  4HCl  +  MnOa 


LIQUOR  CHLORI—  SOLUTION  OF  CHLORINE   (CHLORINE  GAS  DIS- 
SOLVED IN  WATER). 

PREPARATION.  —  This,  the  officinal  solution,  is  formed  by  passing  the 
gas  through  a  wash-bottle  into  a  receiver  containing  distilled  water,  which 
dissolves  it. 

CHARACTERS  AND  TESTS.  —  The  liquor  chlori  is  slightly  greenish  in 
color,  smelling  strongly  of  the  gas,  and  possessing  its  bleaching  and  dis- 
infectant properties  —  sp.  gr.  1.003.  On  evaporation  it  should  leave  no 
residue. 

Under  the  influence  of  light,  chlorine  slowly  decomposes  water  with 
production  of  hydrochloric  acid  and  oxygen,  and  the  solution  then  loses 
its  characteristic  properties.  Hence  the  advantage  of  preparing  it  fresh 
for  use,  and  the  necessity  of  employing  stoppered  dark-colored  bottles  for 
preserving  it.  The  hypochlorites  of  lime,  soda,  and  potash  owe  their 
special  properties  to  the  presence  of  chlorine,  and,  as  commonly  met  with, 
are  mixtures  of  hypochlorites  and  chlorides,  and  are  known  by  the  name 
of  the  latter,  as  "  chloride  of  lime,"  "  chloride  of  soda,"  etc.  A  solution 
of  the  soda  salt  is  known  as  "  Eau  de  Labaraque,"  from  the  chemist  who 
popularized  it,  and  a  solution  of  the  potash  salt  is  fne  "  Eau  de  Javel  "  of 
Parisian  laundries.  Under  the  influence  of  feeble  acids,  e.g.,  the  car- 
bonic acid  of  the  atmosphere,  these  salts  evolve  free  chlorine  until  wholly 
decomposed. 

The  main  chemical  character  of  chlorine  is  its  energetic  affinity  for 
hydrogen,  which  gas  it  will  abstract  both  from  its  aqueous  and  gaseous 


CHLORINE.  121 

combinations.  In  contact  with  organic  substances  it  is  inactive  if  they 
are  quite  dry,  but  if  any  moisture  be  present,  nascent  oxygen,  or  ozone, 
is  liberated  under  the  action  of  chlorine,  and  destroys  or  assists  the  com- 
bustion of  the  organic  compound.  A  concentrated  solution  destroys  the 
lower  forms  of  organic  life,  and  the  gas  brought  into  contact  with  sul- 
phuretted hydrogen  decomposes  it,  hydrochloric  acid  being  formed,  and 
sulphur  precipitated.  Hence  chlorine  is  a  good  disinfectant  and  deodorant, 
but  limited  in  its  power,  for  after  it  has  once  caused  the  oxidation  of  or- 
ganic matter,  or  become  changed  into  hydrochloric  acid,  its  disinfectant 
qualities  are  almost  lost;  also  its  strongly  corrosive  action  limits  its  use. 

ABSORPTION  AND  ELIMINATION. — Chlorine  gas  may  be  absorbed  through 
the  lungs,  as  proved  by  finding  its  odor  in  the  brain  after  death  from  its 
inhalation  (Cameron).  A  dilute  solution  when  swallowed  combines  with 
the  alkaline  salts,  either  in  the  stomach  or  the  blood,  to  form  chlorides, 
and  as  such  passes  out,  mainly  by  the  kidneys.  Huserriann  suggests  that 
hydrochloric  acid  rather  than  chlorides  may  be  formed  from  small  doses. 

The  hypochlorites,  decomposed  in  part  by  the  gastric  acid,  give  off 
free  chlorine,  and  then  passing  into  the  circulation,  are  excreted  as  chlo- 
rides of  potassium  and  sodium.  Kletzinski  ascertained  this,  and  taking 
himself  for  a  fortnight  a  daily  dose  of  60  gr.  of  "chloride  of  soda"  (hypo- 
chlorite),  found  an  increase  of  30  to  40  gr.  of  sodium  chloride  in  the 
urine  (Canstatt:  Jahrbucher,  1851,  Bd.  i.).  Some  amount  of  free  chlorine 
would  also  seem  to  pass  in  that  secretion,  for  after  absorption  of  the  gas 
(in  a  chlorine  bath)  Wallace  found  the  urine  to  possess  bleaching  prop- 
erties, though  neutral  to  litmus  paper. 

PHYSIOLOGICAL  ACTION  (EXTERNAL). — Chlorine  acts  as  an  irritant, 
causing,  when  applied  in  vapor  or  strong  solution  to  the  skin,  a  sense  of 
prickling,  with  perspiration,  congestion,  and  sometimes  erysipelatous,  pap- 
ular, or  vesicular  eruptions.  Chlorine  water  long  applied  causes  a  fatty 
degeneration  and  peeling  off  of  the  upper  layers  of  the  cuticle  (Bryk). 

On  denuded  surfaces  or  mucous  membranes  the  irritant  effect  is  still 
more  marked — the  liquor  sodse  chloratas,  for  instance,  if  applied  too 
strong  to  the  throat  or  vagina,  causes  much  discomfort.  The  vapor,  if 
much  diluted  with  air,  may  be  breathed  without  other  symptoms  than  a 
sense  of  heat  and  subsequent  increase  of  expectoration;  but,  if  breathed 
in  full  strength,  it  acts  as  a  violent  irritant  to  the  respiratory  tract,  causing 
spasms  of  the  glottis,  convulsive  cough,  and  a  sense  of  severe  constriction 
and  suffocation.  Death  may  follow  from  inhaling  an  atmosphere  of  only 
1  per  cent,  chlorine,  not  from  convulsive  closure  of  the  glottis,  as  for- 
merly thought,  but  from  the  intense  irritation  excited,  as  shown  during 
life  by  the  pain,  cough,  bloody  sputa,  etc.,  and  after  death  by  the  secre- 
tion in  the  finer  bronchi,  hepatization  of  lungs,  and  (seldom)  tracheal 
croup  (v.  Hassell  and  Mulder,  Eulenberg). 

Some  degree  of  toleration  of  chlorine  may  be  established,  for  in  bleach- 


122  MATERIA    MEDICA    AND    THERAPEUTICS. 

ing  works  the  men  can  remain  many  hours  where  a  stranger  is  at  once  at- 
tacked with  coughing  and  irritation. 

PHYSIOLOGICAL  ACTION  (INTERNAL). — The  general  systemic  action  of 
chlorine  is  that  of  a  stimulant,  more  or  less  in  degree,  according  to  the 
quantity  absorbed;  and  there  is  no  sufficient  evidence  of  the  calmative 
properties  described  by  Albers. 

Circulatory  System. — Brought  into  contact  with  blood-serum,  it  co- 
agulates the  albumen,  loses  its  characteristic  odor,  and  forms,  after  a 
time,  hydrochloric  acid.  In  animals  dying  under  chlorine-inhalation,  the 
blood  becomes  dark  red,  thick,  and  finely  granular,  from  similar  coagula- 
tion of  albumen  (Eulenberg).  A  solution  injected  into  the  jugular  vein 
destroys  life  with  symptoms  of  asphyxia,  and  the  blood  then  also  is  found 
dark  red,  but  fluid  (Nysten). 

In  man,  normal  circulation  and  respiration  are  quickened  under  the 
moderate  influence  of  chlorine.  Husemann,  however,  states  that  in  ty- 
phus fever  the  pulse  and  temperature  become  lower  under  it,  and  he  con- 
nects such  effect  with  conversion  of  the  remedy  into  hydrochloric  acid. 

Digestive  System. — The  same  observer  traces  to  this  acid  change  also 
an  increase  of  appetite  and  digestive  power,  but  an  excessive  dose  de- 
ranges the  stomach.  Workmen  exposed  to  the  fumes  of  the  gas  suffer 
from  acid  dyspepsia  and  various  symptoms  traceable  to  gastric  irritation; 
it  is  not  likely  that  any  blood-change  should  occur  from  continuous  ex- 
posure to  the  dilute  gas,  but  it  is  possible  that  some  local  solution  of  gastric 
epithelium  may  follow  the  constant  contact  of  hydrochloric  acid  formed 
and  swallowed  in  the  buccal  secretions. 

Glandular  System — Nutrition. — Chlorine  has  been  credited  with  a 
stimulant  action  upon  the  liver  and  kidney.  Kletzinsky  asserts  that  the 
excretion  of  urea  is  increased  under  its  use,  and  Gubler  has  observed 
emaciation,  implying  increased  tissue  change.  Husemann  only  remarks 
that  its  power  of  stimulating  the  hepatic  and  renal  functions  "  requires 
confirmation."  The  faeces  are  said  by  some  observers  to  become  light- 
colored  under  its  use,  suggesting  an  alteration  in,  or  lessened  secretion 
of  the  bile. 

SYNERGISTS. — Antiseptics  and  deodorants. 

ANTIDOTES  AND  INCOMPATIBLES. — In  gaseous  poisoning  by  chlorine 
chemical  antidotes  are — Sulphuretted  hydrogen,  which  forms  hydrochloric 
acid  (itself,  however,  corrosive  to  the  bronchi) ;  ammonia,  which  forms  a 
chloride  of  ammonium;  and  solutions  of  anilin  (Husemann),  which  also 
coagulate  albumen  and  are  caustic.  Probably  the  best  remedy  is  steam 
inhalation. 

Poisoning  by  the  solution  is  best  treated  by  albumen  or  milk  with  mag- 
nesia. Kastner  says  alcohol  and  sugar  are  useful.  For  medicinal  pur- 
poses, prussic  acid  and  vegetable-colored  infusion  should  not  be  prescribed 
with  it. 


CHLORINE.  123 

THERAPEUTICAL  ACTION  (EXTERNAL). — Aphthae — Angina. — As  a  lo- 
cal detergent  and  disinfectant,  chlorine  solution  is  very  serviceable.  In 
cases  of  aphthous  stomatitis  I  have  known  it  quickly  relieve  when  borax 
has  failed. 

In  ulceration  of  the  fauces,  whether  scarlatinal,  septic,  or  syphilitic, 
a  gargle  containing  about  £  dr.  of  liquor  chlori  in  6  oz.  of  water,  is  one  of 
the  best  for  removing  unhealthy  discharge  and  slough;  in  salivation  also 
it  is  useful. 

Wounds — Chancre. — A  lotion  containing  chlorinated  soda  or  liquor 
chlori,  about  1  part  in  12  of  water,  is  a  good  dressing  for  unhealthy  sup- 
purating wounds,  and  for  chancres. 

Purulent  and  Fetid  Discharges.  —  An  injection  prepared  with  the 
chlorine  solutions  (1  part  in  12)  is  effective  in  cases  of  offensive  lochia 
after  delivery,  during  puerperal  peritonitis,  etc.  I  have  found  it  act  bet- 
ter than  Condy's  fluid,  but  it  produces  some  dryness,  smarting,  and  irri- 
tation, if  used  too  strong. 

If  an  injection  be  required  in  Chronic  Empyema,  one  with  chlorine 
is  very  suitable,  and  freer  from  risk  than  some  other  remedies.  In  Gonor- 
rhoea injections  of  chloride  of  lime  have  proved  curative. 

As  a  disinfectant  for  the  hands  after  dissections  or  post-mortem  ex- 
aminations, liquor  chlori  is  efficient.  This  was  proved  on  a  large  scale 
some  years  ago  at  the  Vienna  Maternity  Hospital,  when  the  students 
were  accustomed  to  pass  from  the  necropsies  to  the  bedside.  At  one  time 
the  mortality  amounted  to  30  per  month,  but  after  the  introduction  of  a 
chlorine  wash  for  the  hands,  to  be  used  before  and  after  every  post-mor- 
tem examination,  the  mortality  fell  to  about  7  per  month,  the  ordinary 
average  ( Medico-  Chirurgical  Transactions,  vol.  xxxii.). 

As  an  aerial  disinfectant,  the  value  of  chlorine  has  been  variously  es- 
timated. When  cholera  appeared  in  1830  and  1831,  chlorine-fumigation 
was  officially  ordered  for  clothes,  wool,  and  other  imports,  but  there  was 
no  satisfactory  proof  of  its  efficacy.  The  Board  of  Health  reports  of  that 
period,  with  the  evidence  of  Gregory,  Tweedie,  and  others,  rather  nega- 
tive its  value  in  limiting  the  spread  of  fever;  and  Bousquet  reported  that 
chlorine  would  not  prevent  the  activity  of  vaccine  virus  (Lancet,  ii.,  1831). ' 
On  the  other  hand,  Schoenlein  and  Eisenmann  report  its  value  in  scarlet 
fever,  and  more  recently,  Dr.  Peter  Hood  expresses  great  confidence  in 
it  in  this  disorder.  He  uses  towels  and  sheets  wrung  from  a  strong 
solution  of  chloride  of  lime,  and  placed  about  the  room  and  before  the 
door;  he  states  that  he  has  never  known  infection  spread  when  this  was 

1  Dr.  Baxter  has  shown,  however,  that  chlorine,  added  in  quantity  sufficient  to 
render  the  lymph  acid,  abolishes  its  infective  power,  and  in  the  same  series  of  experi- 
ments found  that  chlorine  in  the  proportion  of  .078  per  cent,  or  more,  is  equally  anti- 
dotal to  the  virus  of  infective  inflammation  (Report  of  Medical  Officer  of  Privy  Coun- 
cil and  Local  Government  Board,  new  series,  No.  vi.). 


124  MATEKIA   MEDICA   AND    THERAPEUTICS. 

practised.  Internally  he  gives,  at  first,  a  purgative  or  emetic,  and  after- 
ward quinine,  with  the  best  results  (Lancet,  i.,  1869).  Mr.  Stone  (Man- 
chester) reported  the  vapor  effective  in  staying  the  spread  of  cattle-plague ; 
he  disengaged  it  by  dropping  a  few  grains  of  chlorate  of  potash  into  a 
wine-glass  two-thirds  full  of  muriatic  acid,  every  six  or  eight  hours;  and 
invented  an  arrangement  for  the  continuous  and  regulated  supply  of  the 
gas  in  hospital  wards,  etc.  (Lancet,  ii.,  1867). 

The  general  opinion  of  the  profession,  and  the  general  result  of  ex- 
periment, is  rather  against  the  possibility  of  controlling  infection  by  this 
means,  at  least  by  a  chlorinated  atmosphere  dilute  enough  to  be  respira- 
ble;  it  must  be  considered  doubtful  whether  emanations  from  vessels  con- 
taining lime  chloride,  or  from  sheets  saturated  with  it,  really  exert  a  rem- 
edial effect,  though  as  a  measure  of  precaution  they  may  be  worth  using. 
In  an  empty,  closed  chamber,  the  gas,  no  doubt,  is  effective,  and  may  be 
used  as  described  under  manganese,  but  for  general  purposes  sulphurous 
acid  is  better. 

Phthisis. — The  literature  of  forty  years  ago  contains  many  cases  of 
phthisis  treated  apparently  with  benefit,  both  in  France  and  this  country, 
by  inhalation  of  chlorine. 

Elliotson  recorded  some  advantage  from  it,  and  I  remember  Sir  James 
Simpson. speaking  well  of  the  method,  and  pointing  out  that  bleachers 
did  not  usually  get  phthisis,  and  that  the  air  of  bleaching  works  was  found 
to  cure  cough.  Further  experience  has  not  corroborated  the  expectations 
formed,  although  in  cases  of  offensive  and  copious  expectoration  some 
benefit  may  be  derived  from  chlorine-inhalation. 

In  JBronchiectasis  and  Gangrene  of  Lung,  chlorine-inhalations  may 
certainly  give  much  relief  by  their  stimulant  and  disinfectant  power. 

THERAPEUTICAL  ACTION  (INTERNAL). —  Chronic  Hepatic  Congestion. 
— On  the  hypothesis  that  chlorine  stimulates  the  biliary  flow,  liquor  chlori 
has  been  given  internally  in  hepatic  congestion,  and  Wallace  wrote  in 
favor  of  vapor  baths  containing  chlorine.  It  is  one  element,  at  least,  in 
the  benefit  often  given  by  nitro-muriatic  acid,  internally  or  in  bath;  but 
chlorine  alone  is  not  depended  upon  in  modern  practice. 

In  Scarlatina,  the  liquor  chlori  has  been  recommended,  and  acid  solu- 
tions of  free  chlorine;  but  I  think  there  are  better  remedies. 

PREPARATIONS  AND  DOSE. — Liquor  chlori :  dose,  10  to  30  min.,  freely 
diluted.  Vapor  chlori  (inhalation  of  chlorine) :  take  of  chlorinated  lime 
2  oz.,  water  (cold),  a  sufficiency;  put  the  powder  into  a  suitable  appara- 
tus, moisten  it  with  water,  and  let  the  vapor  that  arises  be  inhaled. 

[Liquor  chlori,  Br.  P.— Aqua  chlorinii,  U.  S.  P.~[ 


WATER.  125 


AQUA— WATEK,  H,O,=18. 

Pure  natural  water  is  a  limpid,  colorless  fluid,  free  from  taste  or  odor. 
When  evaporated,  it  should  leave  no  residue.  In  the  Pharmacopoeia  it 
occurs  as  "  aqua  destillata — distilled  water,"  but  ordinary  water  is  much 
more  extensively  used  in  practice. 

ABSORPTION  AND  ELIMINATION. — Water  is  readily  absorbed  into  the 
blood,  and  especially  so  if  the  normal  systemic  amount  has  been  tempo- 
rarily lessened  by  excessive  excretion  of  urine,  perspiration,  hemorrhage, 
etc.  When  the  system  already  contains  a  normal  amount,  then  an  extra 
quantity  is  less  readily  taken  up.  Elimination  occurs  by  the  kidneys,  the 
intestines,  the  skin,  and  the  lungs,  and  of  any  given  portion  it  is  com- 
monly completed  within  six  hours,  though  during  strong  exercise  the 
muscles  retain  liquid  for  a  longer  time.  Of  that  taken,  the  greater  part 
passes  out  by  the  kidneys,  augmenting  their  functional  activity  and  carry- 
ing off  a  proportionately  increased  amount  of  urea,  phosphoric  acid,  and 
sodium  chloride.  If  the  extra  quantity  of  water  taken  be  within  moder- 
ate limits  the  increased  elimination  is  accompanied  or  soon  followed  by 
increased  absorption. 

PHYSIOLOGICAL  ACTION  (EXTERNAL). — This  varies  much  according  to 
the  form  of  application,  whether  in  large  or  small  quantity,  by  douching, 
immersion,  or  wet  sheets,  etc. ;  and  again  according  to  the  temperature, 
cold,  tepid,  or  warm,  and  according  to  the  shorter  or  longer  time  during 
which  the  patient  is  exposed  to  it.  It  is  desirable,  therefore,  to  consider, 
in  some  detail,  the  different  modes  of  its  application. 

The  Cold  Bath. — Temperature  from  40°  to  CO0  F.,  according  to  the 
season.  What  is  said  under  "sea-bathing"  (v.  pp.  151,  152)  applies  al- 
most equally  to  the  ordinary  cold  bath  taken  with  a  plunge.  There  is  a 
sudden  feeling  of  chilliness  with  roughening  of  the  skin  (goose-flesh), 
some  blueness  of  lips,  catching  of  breath,  and  lowering  of  pulse.  But  in 
a  few  moments,  in  fairly  healthy  persons  (and  only  such  should  take  this 
form  of  bath),  "  reaction"  sets  in,  with  sense  of  warmth  and  exhilaration, 
quickening  of  pulse  and  respiration,  and  augmented  muscular  power. 
The  first  effect  is  due  in  part  to  altered  conditions  of  circulation  (the 
superficial  vessels  being  for  the  moment  emptied,  and  the  internal  vessels 
congested),  and  in  part  to  the  sudden  shock  felt  by  the  large  peripheral 
expanse  of  sensitive  nerve-tissue  in  the  skin.  That  the  nerve-centres  can 
transfer  and  transmute  the  sensations  and  effect  of  cold,  as  well  as  other 
sensations,  might  be  taken  for  granted,  but  a  familiar  illustration  of  the 
fact  is  presented  when  one  hand  only  is  immersed  in  cold  water,  and  the 
sensation  is  transmitted  to  the  cord  and  brain,  and  thence  reflected  to  cor- 
responding nerve-connections  on  the  opposite  side,  so  that  the  temperature 
of  this  opposite  limb  is  also  lowered.  That  the  blood-supply  of  internal 


126  MATERIA    MEDICA    AND    THERAPEUTICS. 

organs  may  be  controlled  by  external  applications  is  proved,  inter  alia, 
by  the  observed  contraction  of  renal  arterioles  when  ice  is  applied  to  the 
lumbar  region  (Brown-Se'quard),  and  by  the  immediate  diminution  of  the 
volume  of  a  congested  liver  and  spleen  under  the  influence  of  cold  douch- 
ing (Fleury). 

The  general  effect  of  a  short  and  satisfactory  cold  bath  is  "  tonic." 
The  blood  circulates  more  freely,  and  tissue-change  is  increased;  yet,  con- 
currently, appetite  and  digestive  power  are  so  far  improved  that  during 
a  course  of  such  baths  weight  is  commonly  gained. 

The  too-prolonged  cold  bath,  used  only  through  imprudence  by  the 
healthy,  or  for  definite  curative  results  in  the  hyperpyrexial  patient,  has 
a  very  different  effect.  The  primary  reaction  is  succeeded  by  coldness, 
depression,  weakened  circulation,  and  an  exhaustion  which  may  progress 
to  collapse.  The  temperature  is  steadily  lowered,  the  blood  accumulates 
in  the  great  venous  trunks,  capillary  circulation  and  tissue-change  gener- 
ally are  interfered  with,  and  reflex  symptoms,  such  as  nausea,  vomiting, 
and  syncope,  may  follow.  Pugibert  and  Bailey  have  lately  described  a 
scarlatiniform  flush,  limited  or  diffused,  as  occurring  from  the  cold  bath. 
According  to  two  cases  reported  by  them,  this  rash  is  the  precursor  of 
shivering,  lividity,  and  a  syncope  which  might  prove  fatal  if  it  occurred  in 
deep  water  (Medical  Record,  August  15,  1879).  In  the  clinical  use  of 
the  cold  bath  such  results  are  avoided  by  careful  watching  and  thermo- 
metric  observation. 

Intense  cold  is  an  anaesthetic /  a  mixture  of  ice  and  salt  applied  to  the 
skin  for  a  few  moments  causes  it  to  assume  a  white  or  leaden  hue,  and 
in  this  state  incisions  can  be  made  into  it  quite  painlessly;  the  rapid  evap- 
oration of  ether  thrown  on  to  the  part  in  fine  spray  is  also  used  to  pro- 
duce the  same  effect. 

Wet  Towels — The  Wet  Sheet. — A  milder  method  of  using  cold  water 
is  in  the  form  of  towels,  or  a  sheet,  wrung  out,  and  applied  with  vigorous 
friction;  it  is  free  from  the  risk  of  serious  shock  to  delicate  subjects,  and 
is  commonly  and  properly  applied  before  commencing  with  cold  immer- 
sion. 

The  towel  friction  is  given  first  to  the  upper  part  of  the  body  while 
the  patient  sits  with  the  lower  limbs  still  covered;  that  is  to  say,  the 
whole  surface  is  not  exposed  at  one  time.  Where  there  is  a  very  feeble 
state  of  circulation,  or  when  the  breathing  is  much  oppressed,  the  water 
may  at  first  be  at  80°  or  90°  F.,  and  gradually  lowered  to  cold,  and  more 
of  it  left  in  the  towel  as  the  power  of  reaction  improves.  Under  this 
"  graduated  stimulation,"  a  pale,  bloodless,  and  sensitive  skin  may  be 
educated  to  a  good  power  of  reaction,  with  marked  relief  to  chilliness 
and  to  the  frequent  recurrence  of  catarrh,  and  there  are  scarcely  any  pa- 
tients— certainly  none  who  retain  the  power  of  taking  and  digesting  food 
— that  cannot  receive  towel-rubbing  with  advantage.  In  catarrhal  sub- 


WATER.  127 

jects,  however,  special  care  should  be  used  in  avoiding1  exposure  at  first, 
or  harm  may  result. 

The  wet- sheet  friction  is  somewhat  more  trying,  since  it  should  always 
be  used  cold,  and  the  patient  stands,  quite  uncovered,  while  the  sheet  is 
thrown  over  the  shoulders  and  round  the  whole  body,  and  friction  is  ap- 
plied by  making  folds  in  the  sheet,  not  by  simply  rubbing  the  smooth 
surface.  This  should  be  continued  for  two,  three,  or  four  minutes.  It  is 
suitable  for  persons  not  much  accustomed  to  cold  water,  but  with  a  fair 
amount  of  vital  power.  "  It  rouses  all  the  activity  of  the  nerves  and 
blood-vessels  of  the  skin,  without  taking  much  animal  heat  from,  or  call- 
ing for  much  organic  exertion  of  the  frame,  and  while  doing  this  it  trans- 
mits to  the  nervous  centres  the  genial  stimulation  which  it  impresses  on  the 
great  nervous  outer  covering  of  the  body  "  (Gully).  It  relieves  fatigue, 
and  may  be  taken  when  a  cold  bath  would  be  unsuitable;  it  relieves, 
also,  nerve-depression  and  early  stages  of  catarrh  and  neuralgia.  To  use 
a  warm  sheet,  unless  followed  by  a  cold  one,  is  not  attended  with  any  of 
the  good  effects  of  this  kind  of  bath;  by  a  sheet  so  wet  as  to  be  "drip- 
ping "  a  more  powerful  effect  is  exerted,  whilst  by  wringing  the  sheet 
very  dry  from  the  cold  water,  quicker  reaction  will  be  ensured.  The  pa- 
tient should  not  attempt  to  rub  himself  much,  or  make  any  violent  exer- 
tion during  this  process,  otherwise  he  may  be  annoyed  by  giddiness  or 
palpitation. 

Shallow  Bath. — This  is  given  with  about  six  inches  of  water  in  a 
bath  long  enough  for  the  patient  to  sit  with  the  legs  in,  though  he  need 
not  lie  down.  The  water  should  be  splashed,  and  rubbed,  and  thrown 
over  the  body  by  means  of  a  towel  used  by  an  attendant  at  the  back, 
while  the  patient  splashes  his  front  for  from  one  to  five  minutes,  accord- 
ing to  the  reactive  power.  The  frequent  change  of  the  splashing  water 
against  the  body  lowers  temperature  for  the  moment,  and  rigorous  fric- 
tion is  required  afterward,  or  walking  exercise.  The  same  bath  more  or 
less  completely  given,  is  the  ordinary  morning  "  tub  "  of  average  English- 
men, and  exerts  an  excellent  tonic  and  anticatarrhal  effect.  During 
acute  febrile  disorder  the  shallow  bath  may  be  used  at  70°  to  80°  F.,  and 
much  exertion  is  not  desirable,  nor  is  friction  required;  but  in  the  ab- 
sence of  acute  disorder  it  should  always  be  taken  cold  in  summer,  or  at 
about  60°  F.  in  winter,  and  be  followed  by  exercise.  Its  ultimate  effect 
is  to  equalize  circulation,  but  it  encourages  it  especially  in  the  lower  ex- 
tremities, and  so  relieves  the  head  and  the  viscera. 

The  Pail  Douche  is  administered  by  throwing  two  to  four  pails  of 
water  (six  or  eight  gallons  at  a  time)  over  the  shoulders,  against  the 
back,  or  the  front  of  the  chest,  as  the  patient  sits  in  a  long  bath.  A  dry 
towel  friction  follows.  This  process  adds  the  shock  of  dashing  water  to 
the  splashing  of  the  shallow  bath,  and  imitates,  to  some  extent,  the  wave- 
stroke  of  the  open  air  sea-bath.  It  needs  more  power  of  reaction  than 


128  MATERIA   MED1CA    AND    THERAPEUTICS. 

the  baths  already  mentioned,  and,  if  well  borne,  has  much  more  effect  in 
relieving  internal  congestion,  whether  of  the  liver,  the  uterus,  or  the 
nerve-centres.  The  amount  of  force  used,  and  the  number  of  pails, 
should  be  varied  with  the  vital  conditions  of  the  patient.  In  chronic  he- 
patic and  cerebral  congestion,  usually  much  force  will  be  borne. 

Spinal  Washing. — This  is  a  mild  and  local  form  of  douching  from  a 
jug,  or  can,  or  large  sponge,  emptied  along  the  spine  as  the  patient  sits 
on  a  board  placed  across  the  front  of  a  bath.  It  may  be  continued  from 
two  to  ten  minutes,  and  sometimes  should  be  commenced  at  80°,  and 
gradually  cooled  down,  until  after  a  few  baths  it  can  be  borne  wholly 
cold.  If  commenced  too  cold,  in  sensitive  subjects  it  may  give  rise  to 
headache  or  giddiness,  and  if  continued  too  long  may  induce  a  rheumatic 
condition  of  the  back-muscles,  and  is  not  free  from  risk  to  the  kidneys. 
It  would  seem  that  the  spinal  cord  is  directly  stimulated  by  the  shock  of 
cold  water,  and  that  the  stimulus  is  reflected  to  peripheral  and  visceral 
nerves;  hence,  according  to  hydropathic  authorities,  "a  divergent  effect 
on  the  action  of  the  heart,  stomach,  kidneys,  uterus,  etc."  It  is  proba- 
ble, also,  that  the  sympathetic  ganglia  are  directly  stimulated,  and  this 
bath  is  useful  in  functional  torpor,  marked  by  numbness  or  slight  paraly- 
sis of  limbs,  constipation,  and  phosphaturia,  etc.  Certainly,  a  very  bra- 
cing effect  and  pleasant  glow  may  be  produced  by  a  moderate  cold  wash 
to  the  spine,  followed  by  manual  friction,  and  the  effect  may  be  further 
developed  by  the  use  of  a  "  rubbing  wet  sheet "  to  the  whole  surface  for 
a  few  minutes  afterward. 

The  Douche. — This  bath  is  the  most  powerful  and  the  most  important 
within  the  domain  of  hydro-therapeutics,  and  has  been  made  the  basis  of 
the  system  practised  with  much  success  by  Dr.  Fleury,  at  Bellevue  (Paris). 
Its  effect  varies  with  its  size,  force,  direction,  duration,  and  temperature. 
It  may  be  a  column  of  water  from  one  to  three  inches  in  diameter,  falling 
twelve  to  twenty  feet,  or  propelled  at  right  angles  to  the  patient's  body. 
It  may  be  broken  up  into  fine  streams  by  a  rose,  or  into  more  numerous 
jets,  arranged  to  play  at  once  on  the  body  from  different  quarters  (douche 
du  cercle — needle  douche).  Again,  it  may  be  used  tepid,  hot,  or  cold, 
or  all  three  at  one  sitting,  and  its  duration  may  vary  from  ten  to  sixty 
seconds,  or  in  healthy  people  more. 

The  cold  douche  should  be  commenced  cautiously,  after  due  estima- 
tion of  the  patient's  reactive  power,  and  if  there  be  much  debility,  it 
should  be  applied  at  first  to  the  extremities  only,  and  for  a  very  brief  pe- 
riod— ten  to  fifteen  seconds;  this  is  a  most  important  point:  it  should 
never  be  applied  to  the  head.  In  disease,  the  douche  is,  as  a  rule,  suit- 
able only  for  chronic  cases,  but  with  careful  management  may  be  applied 
to  almost  all  conditions. 

According  to  Dr.  Howard  Johnson,  the  cold  douche  markedly  increases 
the  respiratory  acts,  and  "  thereby  imparts  an  enlivening  influence  to  all 


WATER.  129 

the  vital  phenomena."  "  It  is  a  diffusible  stimulant,  and  is  comparable 
to  ammonia,"  though  it  does  not  always  quicken  the  pulse.  According 
to  Fleury,  the  general  douche,  in  shower,  jet,  or  circle,  is  powerfully  tonic 
and  reconstitutive,  by  virtue  of  its  action  on  the  circulation.  With  an 
increased  force  of  percussion,  rapid  movement  from  one  part  to  another, 
and  fine  division  of  the  liquid,  a  more  exciting  effect  is  produced.  By 
directing  the  stream  upon  various  parts  in  such  force  as  to  congest  them, 
a  revulsive  action  is  made  to  relieve  the  congestion  of  other  parts;  thus, 
metrorrhagia  and  vomiting,  even  when  dependent  upon  a  uterine  polypus, 
have  ceased  under  a  course  of  cold  douching  (Fleury,  third  ed.,  p.  297), 
and  the  volume  of  the  liver  and  spleen  has  markedly  diminished.  Andral 
and  Piorry  verified  the  extent  of  hepatic  dulness  in  a  certain  patient  as 
18  centimetres  (vertical)  and  11  centimetres  to  the  left  of  the  median 
line  (horizontal),  and  agreed  that  immediately  after  an  energetic  douche, 
the  former  measurement  was  reduced  by  \  centimetre,  the  latter  by  5 
centimetres;  and  in  another  case,  the  spleen,  which  measured  at  the  com- 
mencement of  treatment  23  centimetres  vertically  and  15  transversely, 
measured  only  9  and  7  centimetres  respectively  after  six  days  of  repeated 
local  douching.  The  effect  on  other  organs  is  similar,  though  less  rapid. 
But  in  chronic  cases,  it  is  important  not  to  induce  such  results  too  quick- 
ly, since  fresh  and  more  serious  congestion  may  be  produced  elsewhere. 

In  certain  disorders,  such  as  dropsy  or  effusion  into  joints,  absorption 
has  been  markedly  stimulated  by  the  douche  (Fleury). 

The  Sitz  Hath. — A  valuable  influence  may  be  exerted  not  only  on 
the  pelvic  organs,  but  indirectly  on  the  whole  system,  by  sitting  in  water 
of  varying  depth  and  temperature  (60°  to  80°  F.)  and  for  a  time  varying 
from  5  to  30  minutes.  "The  immense  network  of  nerves  which  supplies 
the  whole  of  the  organs  contained  within  the  hips  and  the  lower  belly,  and 
the  lower  third  of  the  spinal  cord,  terminating  in  great  leashes  of  nerves, 
are  the  sensitive  points  upon  which  the  sitz  bath  operates"  (Gully).  It 
certainly  "  draws  blood  from  the  brain,"  and  is  one  of  the  best  means  of 
insuring  sleep.  It  relieves  fatigue,  improves  appetite  and  digestion,  less- 
ens headache  and  giddiness,  regulates  the  bowels,  and  the  uterine  flow, 
and  the  action  of  the  kidneys,  often  augmenting  them  when  deficient,  or 
lessening  if  excessive. 

To  obtain  these  good  effects  it  is  most  important  that  thorough  reac- 
tion be  secured  by  friction  or  exercise,  or  warm  clothing,  otherwise  shiv- 
ering and  depression  come  on.  It  may  be  advisable  to  commence  with 
tepid  water,  or  a  more  powerful  stimulus  may  be  given  by  a  "  running 
sitz,"  fresh  cold  water  constantly  entering  the  bath  and  circulating  round 
the  body.  Or  again,  a  local  douche  may  be  made  to  act  upon  the  lumbar 
region,  the  perineum,  the  uterus,  etc.,  whilst  the  ordinary  sitz  bath  is  in 
progress.  The  general  effect  of  the  cold  sitz  bath  is  sedative.  It  slows  the 
pulse  to  the  extent  of  10  or  15  beats  during  the  first  five  minutes — of  20 
VOL.  I.— 9 


130  MATERIA    MEDIC  A    AND   THERAPEUTICS. 

beats  in  the  course  of  half  an  hour  (H.  Johnson).  It  also  lowers  the 
respiration,  though  very  slightly,  and  it  lessens  the  body  temperature. 
By  its  rubefacient  effect,  the  sitz  bath  acts  also  as  a  derivative  or  counter- 
irritant. 

Foot-Baths. — The  immersion  of  the  feet  produces  some  of  the  effects 
of  the  sitz  bath,  but  in  a  minor  degree.  It  lessens  the  amount  of  blood 
in  the  cranial  circulation  and  relieves  flatulence  and  slight  visceral  con- 
gestions. For  all  purposes,  the  thorough-going  hydropathists  use  foot- 
baths cold,  or  at  least  cool,  with  considerable  friction,  but  there  are  some 
subjects  in  whom  the  cold  to  the  feet  produces  serious  symptoms,  and 
others — such  as  the  gouty  and  catarrhal  patients — in  whom  a  hot  foot- 
bath, to  which  mustard  or  pepper  may  be  added,  relieves,  and  under  due 
precaution  as  to  exposure,  does  so  more  pleasantly  and  effectually  than 
the  cold.  Friction  of  the  feet  with  a  "damp  or  dripping  towel"  :s,  how- 
ever, an  intermediate  method  often  available. 

Wet-Packing. — This  is  a  still  more  sedative  process  than  the  sitz 
bath,  since  it  is  applied  over  a  larger  surface,  and  involves  complete  rest. 
To  avoid  unduly  rapid  depression  of  circulation  and  general  activity,  it  is 
often  advisable  to  commence  with  a  partial  packing,  i.e.,  closely  apply- 
ing to  various  parts  folded  towels  wrung  from  cold  water,  and  covered 
with  flannels  and  waterproof  sheeting.  Thus  the  hips  and  loins  may  be 
"packed"  from  the  level  of  the  navel  to  half-way  down  the  thigh;  the 
abdomen,  from  the  lower  edge  of  the  ribs  to  the  hips;  the  chest  proper, 
over  the  ribs,  or  the  whole  front  and  back  of  the  body;  it  is  said  that 
packing  applied  to  the  chest  exhausts  more  than  packing  of  other  parts 
of  the  body  (Gully).  Again,  packing  of  the  lowest  part  of  the  belly  and 
back,  of  the  whole  spine,  or  of  the  sides,  are  other  varieties;  the  wet 
towels  may  be  changed  every  fifteen  to  twenty  minutes  for  an  hour  or 
two. 

The  complete  general  pack  is  applied  by  covering  the  whole  body  with 
a  wet  sheet,  and  this  with  several  blankets,  the  patient  lying  thus  covered 
for  about  one  hour.  This  process  lowers  the  pulse  and  temperature  and 
weight,  and  is  compared  by  Johnson  to  antiphlogistics,  leeches,  calomel, 
and  antimony.  It  may  be  used  at  once  in  chronic  cases  in  sanguineous 
irritable  subjects,  but  should  be  practised  with  caution  in  anaemic  weakly 
persons.  It  usually,  though  not  always,  induces  moderate  diaphoresis, 
and  it  should  be  followed  by  a  shallow  bath  of  two  to  four  minutes'  dura- 
tion, and  then  friction.  The  water,  urea,  and  chloride  of  sodium  in  the 
urine,  are  increased  under  the  use  of  the  wet-pack — slightly  so  from  a 
moderate  use  of  it,  considerably  if  it  be  continued  from  three  to  four 
hours. 

There  is  more  discomfort,  with  chilliness  and  depression,  produced  by 
the  routine  use  of  this  agent  in  hydropathic  establishments,  than  by  any 
other  measure.  In  febrile  conditions  it  may  be  of  the  utmost  value,  but 


WATER.  131 

even  in  such  cases  I  have  seen  serious  results  from  the  exhaustion  in- 
duced. 

Compresses  are  partial  packings,  and  exert  a  marked  local  soothing 
effect.  "They  serve  both  to  prevent  and  to  relieve  irritation,"  and  much 
misery  of  indigestion  and  of  torpid  bowels  is  avoided  by  the  almost  daily 
use  of  a  compress  over  the  stomach.  Various  forms  of  joint-pain  may  be 
relieved  by  the  cold  compress,  and  a  similar  application  to  the  epigas- 
trium will  often  induce  sleep  in  cases  of  insomnia  from  excessive  brain- 
work  or  anxiety. 

The  frequency  of  changing  the  cold  wet  cloth  must  vary  with  the 
effect  desired.  Soothing  is  not  induced  till  a  certain  amount  of  heat  is 
withdrawn  from  the  part,  and  if  the  compress  is  allowed  to  get  too  warm 
it  is  apt  to  stimulate  and  irritate.  In  acute  bilious  attacks,  the  stomach- 
compress  should  be  changed  about  every  two  hours  (Gully) ;  in  chronic 
gastric  irritation,  five  or  six  hours  will  be  a  suitable  time,  and  in  chronic 
pulmonary  disorder,  eight  or  ten  hours;  in  inflamed  throat,  every  six  or 
twelve  hours;  in  contusions,  every  half-hour,  while  in  congestions,  such 
as  of  the  testicle  from  sexual  irritation,  or  of  the  uterus,  every  five  min- 
utes change  for  one  to  three  hours  gives  most  relief. 

Preissnitz,  Fleury,  Gully,  and  others  strongly  object  to  compresses 
being  applied  warm,  but  I  have  often  found  them  useful. 

Warm  JSaths. — By  an  action  contrary  to  that  of  cold  baths,  these  attract 
the  blood  primarily  and  directly  to  the  part  exposed  to  their  influence, 
relaxing  the  vessels  and  tissues,  and  leaving  them  afterward  in  a  condition 
of  lessened  tonicity.  A  similar  effect  is  exerted  by  all  kinds  of  warm 
baths,  but  it  differs  in  degree  according  to  the  temperature  and  duration. 
By  a  tepid  bath  is  meant  one  at  from  70°  to  80°  F.,  and  this  is  chiefly  used 
for  cleansing  and  moistening  the  skin — a  temperature  of  92°  to  98°  F. 
gives  a  warm,  and  upwards  to  112°,  a  hot  bath.  With  the  former  there 
is  at  first  a  pleasant  sense  of  soothing  and  refreshing  warmth,  the  skin 
reddens,  and  the  pulse  quickens  in  frequency,  while  it  lessens  in  tension; 
the  respiration  is  also  quickened,  and  the  temperature  rises.  If  the  bath 
be  too  prolonged,  a  sense  of  languor  comes  on,  and  after  it  there  is  less 
aptitude  for  exertion  than  before.  Under  favorable  conditions,  excretion 
is  increased  from  the  skin,  the  kidneys,  and  the  lungs,  at  the  time  of  the 
bath,  and  oxidation  is  lessened  subsequently. 

In  a  hot  bath,  98°  to  112°  F.,  the  first  sense  of  heat  may  be  painful 
rather  than  pleasant,  then  a  general  stimulating  effect  is  perceived,  the 
whole  surface  becomes  deep  red,  and  the  cutaneous  veins  distended;  relief 
is  thus  given  to  internal  congestion,  to  pain,  and  muscular  spasm  and  con- 
vulsion. Complete  muscular  relaxation  follows,  with  greatly  diminished 
tension  of  the  pulse,  and  increased  frequency  of  heart-action;  before  very 
long,  a  sense  of  oppression  and  distention  may  be  felt  in  the  chest  and 
head  with  general  languor,  giddiness,  or  faintness  from  paralysis  of  vaso- 


132  MATERIA    MEDICA    AND    THERAPEUTICS. 

motor  and  cardiac  inhibitory  nerves.    These  unpleasant  effects  occur  much 
sooner  in  some  persons  than  others. 

By  a  hot  bath  perspiration  is  usually,  but  not  always,  increased;  and 
sometimes  from  the  high  temperature  of  internal  organs  a  restless,  heated 
condition,  similar  to  that  of  true  pyrexia,  may  be  induced  for  a  time. 
This  may  be  noticed,  especially  after  a  too-prolonged  use  of  the  hot  strong 
saline  baths  (Droitwich,  etc.). 

The  length  of  stay  in  a  hot  bath  should  depend  on  the  purpose  to  be 
accomplished,  whether  (1)  mere  excitation  of  circulation  in  the  skin  (which 
is  effected  by  a  short  bath  with  or  without  the  extra  stimulus  of  salt  or 
mustard),  or  (2)  perspiration  and  relief  of  pain  (which  require,  perhaps, 
half  an  hour),  or  (3)  complete  muscular  relaxation  (which  needs  a  pro- 
longed immersion).  In  contradistinction  to  the  ultimate  tonic  effect  of 
the  cold  bath,  decided  loss  of  weight  results  from  a  course  of  warm  bath- 
ing (A.  Steffen). 

Contra-indications. — Since  the  thoracic  organs  and  the  brain  become 
more  or  less  congested  during  a  hot  bath,  its  prescription  needs  as  much 
caution  as  that  of  cold  bathing,  though  for  a  different  reason:  pulmonary 
or  cerebral  vessels  may  even  give  way,  especially  if  the  latter  be  athero- 
matous.  According  to  Dr.  Steffen,  hot-water  baths  are  pre-eminently 
contra-indicated  by  congestion  or  oedema  of  the  lung,  and  Dr.  H.  Wood 
has  seen  under  such  conditions,  "the  most  frightful  dyspnoea  result." 
In  such  an  accident,  cold  effusion  should  be  freely  used. 

Hot  Fomentations. — As  cold  water  may  be  usefully  applied  in  local 
compresses,  hot  water  is  often  of  the  greatest  service  applied  in  fomenta- 
tion, i.e.,  when  a  thickly  folded  flannel,  or  any  thick  absorbent  substance, 
such  as  spongio-piline,  is  completely  wrung  out  of  hot  water,  and  placed 
on  the  affected  part,  covered  with  dry  flannels,  oil-silk,  or  mackintosh 
outside,  to  prevent  evaporation  and  retain  heat,  and  changed  again 
frequently,  the  process  being  continued  for  half  an  hour,  or  even  for 
several  hours  if  necessary.  This  stimulates  the  external  skin  much 
more  strongly  and  suddenly  than  any  cold  compress,  for  every  degree 
above  the  normal  skin-temperature  is  felt  much  more  acutely  than  every 
degree  below  it  (Gully),  and  it  acts  much  better  than  the  more  equable 
heat  given  by  hot  salt,  hot  bran,  or  tins,  or  caoutchouc  bags  of  hot  water, 
because  the  high  temperature  is  more  constantly  renewed. 

f  If  there  be  congestion,  or  even  inflammation  of  an  internal  organ,  it 
may  be  relieved  by  such  external  application  which  is  especially  indicated 
when  the  patient  is  too  feeble  to  react  to  cold,  or  when  the  pain  and  ir- 
ritation are  very  severe,  and  "of  the  mingled  nervous  and  inflammatory 
kind,  with,  if  anything,  an  excess  of  the  former."  The  direct  application 
of  quite  hot  water  causes  contraction  of  small  vessels  and  also  of  the 
uterus. 

Steam-Baths. — The  vapor  of  water,  in  the  form  of  the  steam-bath, 


WATER.  133 

lamp-bath,  hot  wet-packing,  or  Russian  bath  may  be  used  to  accomplish 
still  more  thoroughly  the  same  objects  as  those  to  be  expected  from  the 
warm  or  hot  bath.  In  one  good  form  of  vapor-bath,  the  patient  sits  un- 
clothed in  a  chamber  to  which  steam  is  admitted,  but  the  head  is  outside, 
covered  with  a  cold  cloth.  In  a  less  complete,  but  more  portable  form, 
the  patient  sits  on  a  chair  covered  with  blankets,  while  stearn  is  gener- 
ated by  a  spirit-lamp  placed  under  a  pan  of  water:  or  a  somewhat  similar 
result  may  be  obtained  by  dropping  freshly  burned  lime  into  a  bucket  of 
water  under  the  chair,  or  a  heated  brick  into  hot  water;  or  if  the  patient 
be  too  weak  to  rise,  steam  may  be  conducted  under  the  bed-clothes  raised 
by  hoops;  or  a  heated  brick,  wrapped  in  moistened  cloths  and  flannels, 
laid  near  each  limb.  The  most  complete  form  of  such  bath  is,  however, 
the  Russian  bath,  which  is  given  in  a  closed  chamber  filled  with  steam. 
On  first  entering  the  bath  there  is  often  a  disagreeable  sensation  of  heat 
and  burning  in  the  skin,  the  pulse  becomes  quick,  and  respiration  uneasy; 
sometimes  there  is  a  feeling  of  pressure  on  the  eyes,  heaviness  in  the 
head,  and  dizziness;  but  these  symptoms  soon  pass  away,  and  the  respi- 
ration becomes  more  natural  and  deeper,  the  blood  finds  easier  access 
throughout  the  body,  the  skin  soon  gets  red  and  moist,  and  the  patient 
comfortable. 

Eulenburg  states  that  the  steam-bath  raises  the  body  temperature  to 
a  very  appreciable  degree;  on  an  average  a  steam-bath  of  41°  to  42°  C., 
by  1 J  to  1|  degree  C.  ("  Real-Encyclopaedia,"  1880,  i.,  p.  708). 

Turkish  Bath. — In  conjunction  with  other  baths  should  be  considered 
the  Turkish,  or  Anglo-Turkish  bath,  in  which  dry  air  at  a  temperature, of 
from  100°  to  160°  F.,  or  more,  is  employed,  the  patient  passing  through 
graduated  chambers  during  20  to  40  minutes;  when  free  perspiration  has 
occurred,  and  lasted  for  some  time,  shampooing  is  commenced,  and  after- 
ward the  body  is  washed  with  copious  lathers  of  soap  and  streams  of 
water,  warm,  tepid,  and  finally  cold.  The  effect  of  the  warm  applications 
and  frictions  is  to  stimulate  both  the  general  and  cutaneous  circulation, 
to  relax  the  muscular  tissue,  relieve  pain  and  congestion,  to  cleanse  the 
openings  of  the  skin-glands,  and  to  eliminate  through  them  morbid 
material  and  retained  excretion.  That  the  skin  excretes  urea  has  been 
proved  by  finding  it  in  the  perspiration  of  healthy  persons  (Landerer, 
Funke,  Leube,  etc.);  but  still  more  constantly  in  cases  of  scarlatina, 
nephritis,  cholera,  collapse,  and  chronic  Bright's  disease  (Scottin,  G.  O. 
Rees,  Fiedler,  etc.).  In  such  cases  the  urea  may  even  form  a  crystalline 
powder  on  the  skin,  especially  near  the  sweat-glands  (H.  Wood).  More- 
over, in  diabetes  the  perspiration  contains  sugar;  in  rheumatism,  lactic 
acid;  in  gout,  uric  acid;  and  in  jaundice,  biliary  products.  This  being 
so,  it  is  evident  that  the  promotion  of  very  free  secretion  from  the  skin- 
glands  by  the  varied  processes  of  the  Turkish  bath  is  a  most  efficient 
means  of  depurating  the  blood.  The  effect  of  the  final  cold  douche  or 


134  MATEBIA    MEDICA   AND    THEKAPEUTICS. 

plunge  is  to  contract  muscular  tissue  both  in  the  skin  and  deeper  parts, 
and  to  stimulate  and  brace  up  the  nervous  system;  hence  this  form  of 
bath  combines  the  good  effects  of  both  hot  and  cold  applications.  It 
should  induce  an  agreeable  sense  of  vigor  and  elasticity,  and  render  the 
skin  less  sensitive  to  changes  of  temperature. 

It  does  not,  however,  always  succeed  well;  in  some  subjects,  especially 
at  first,  sweating  is  not  favorably  induced,  and  they  suffer  from  heat, 
malaise,  and  headache;  the  use  of  a  wet  towel  with  friction  should  then 
be  tried,  or  gentle  douching  with  warm  water  on  first  entering  the  bath; 
drinking  cold  water  is  also  recommended  for  increasing  the  skin  secretion, 
and  often  succeeds,  but  in  my  experience  it  has  sometimes  caused  nausea 
and  gastric  pain. 

Persons  vary  in  their  power  of  resisting  heat,  and  although  there  are 
really  few  who  cannot  go  through  a  Turkish  bath  with  safety,  there  are 
many  who  suffer  at  first  with  some  degree  of  oppression,  faintness,  and 
exhaustion.  Hence,  the  first  bath  should  be  taken  cautiously,  not  pro- 
longing unduly  the  time  in  the  hot  chamber — say  not  beyond  20  to  30 
minutes  (the  sensations  will  practically  guide  as  to  time),  and  finishing 
with  the  cold  or  nearly  cold  douche  for  a  few  seconds  only,  not  with  the 
plunge  bath.  It  is  a  mistake  to  go  over-fatigued  into  the  Turkish  bath, 
or  within  three  or  four  hours  after  a  good  meal;  or  to  dress  too  hurriedly, 
and  go  with  still-perspiring  skin  into  the  open  air. 

Centra-indications  to  this  form  of  bath  are  to  be  found  in  extreme 
debility  from  any  cause,  and  in  some  conditions  of  pulmonary  congestion 
or  tendency  thereto:  chronic  heart  disease  per  se  does  not  necessarily  neg- 
ative the  bath,  but  requires  extra  precaution. 

Dry  or  Blanket- Packing. — In  this  process  the  patient  is  enveloped 
in  six  blankets,  one  at  a  time,  each  accurately  adjusted  about  the  throat 
and  feet,  so  as  to  be  air-tight;  a  feather  bed  is  thrown  over  all.  Dr. 
Howard  Johnson  speaks  highly  of  this  treatment,  which  he  credits  with 
producing  the  same  results  as  vapor  or  Turkish  baths,  without  so  much 
general  perturbation.  After  a  time,  the  air  next  the  skin  is  so  far  heated 
as  to  excite  the  circulation,  and  stimulate  a  flow  of  perspiration,  and  after 
this  has  lasted  for  half  an  hour  or  an  hour,  a  shallow  bath  at  70°  or  60° 
F.  and  a  dry  friction  complete  the  process. 

Though  weight  is  temporarily  reduced  and  excretion  increased  by 
this,  as  by  other  warm  baths,  it  does  not  necessarily  follow  that  the  gen- 
eral condition  is  impaired;  on  the  contrary,  in  satisfactory  cases,  even 
after  profuse  sweatings,  weight  is  ultimately  gained  owing  to  increased 
appetite  and  assimilation. 

Mustard-Bathing  or  Packing. — Mr.  S.  Newington  has  drawn  atten- 
tion to  the  powerful  derivative  effects  of  the  hot  mustard-bath.  Two 
handfuls  of  mustard  powder  are  tied  in  a  cloth,  and  pressed  in  hot  water 
till  a  very  strong  extract  is  obtained,  which  is  mixed  with  the  water  of  a 


WATER.  1 35 

full  hot  bath,  and  after  the  patient  has  entered  this  (the  genitals  being- 
protected  by  a  folded  towel),  a  blanket  is  laid  over  the  bath  to  prevent 
irritation  of  the  eyes.  After  five  to  ten  minutes'  stay  the  patient  is  dried 
and  goes  to  bed.  A  similar,  but  milder,  application  is  that  of  a  sheet 
wrung  out  of  mustard  infusion  and  covered  with  waterproof.  The  effect 
is  to  strongly  excite  the  capillary  circulation  in  the  skin,  and  so  to  relieve 
internal  congestion,  especially  of  the  nerve-centres,  and  hence  it  greatly 
disposes  to  sleep  and  quiet  in  conditions  of  mental  excitement.  Under 
packing  of  the  trunk  in  towels  wrung  out  of  the  hot  infusion  the  pulse 
came  down  from  108  to  GO  per  minute  in  the  course  of  two  hours  (Lan- 
cet, i.,  1865).' 

PHYSIOLOGICAL  ACTION  (INTERNAL). — Water  is  an  essential  constit- 
uent of  the  animal  tissues,  and  their  healthy  growth  is  dependent  on  its 
sufficient  supply.  In  passing  through  the  system,  water  (1)  assists  the 
circulation  of  the  nutrient  fluids;  (2)  renders  oxidation  and  other  chemi- 
cal changes  more  active;  (3)  by  its  solvent  action  promotes  absorption, 
secretion,  and  excretion;  and  (4)  by  its  evaporation  from  the  surface  gets 
rid  of  superfluous  heat.  The  tissue-change  produced  by  medicinal  water 
drinking  is  greater  in  the  young  and  delicate  than  in  robust  adults;  it  is 
promoted  by  increase  of  temperature  whether  of  the  water  itself  or  of  the 
atmosphere;  also  by  bodily  exercise  (Parkes).  The  ultimate  result  of  a 
judicious  course  of  water  drinking  is  increase  of  weight,  and  (it  is  said) 
of  fat  (Bartholow),  but  if  an  excessive  amount  be  taken,  the  blood  is  ren- 
dered unduly  fluid,  the  corpuscles  become  paler  and  less  healthy,  and 
general  nutrition  is  impaired. 

Large  draughts  of  cold  water,  especially  if  taken  on  an  empty  stomach 
or  when  the  body  is  heated,  act  injuriously,  by  giving  a  shock  through  peri- 

1  Schuller  (of  Laubbach)  has  studied  the  effect  of  various  applications  of  water  on 
the  cerebral  circulation  of  rabbits  after  trephining  aud  removing  the  cervical  sympa- 
thetic on  one  side.  Compresses  over  the  abdomen  at  50°  F.  caused  dilatation  of  ves- 
Bels  of  the  pia  mater ;  a  general  bath  at  50°  induced  the  same  effect  in  greater  degree. 
After  similar  applications,  but  quite  cold,  a  gradual  contraction  of  cerebral  vessels 
occurred  in  five  to  ten  minutes,  and  lasted  for  about  half  an  hour.  Warm  water,  95° 
to  99°,  applied  in  the  same  manner  caused  marked  contraction  of  the  same  vessels. 
A  douche  over  the  belly  and  back  caused  alternating  changes.  Injections  into  the 
rectum  induced  moderate  dilatation.  Under  a  cold  pack,  gradual  and  strong  contrac- 
tion occurred,  lasting  often  for  two  hours,  pulse  and  respiration  were  slowed,  and  re- 
flex irritability  was  reduced.  Ice  on  the  head  caused,  after  a  time,  moderate  contrac- 
tion ;  friction  over  abdomen  had  the  same  effect.  We  can  scarcely  draw  definite 
practical  conclusions  from  these  observations,  but  it  would  seem  that  tepid  applica- 
tions over  the  body  lead  to  dilatation,  and  quite  cold  or  hot  applications  equally  cause 
contraction  of  cerebral  vessels.  Schuller  considers  that  extreme  degrees  of  tempera- 
ture are  contra-indicated  in  cases  of  hypersemia,  congestion,  and  anaemia  of  brain,  and 
that  the  main  good  effect  of  baths  is  exerted  in  depleting  cerebral  vessels,  in  giving 
tone  to  the  muscular  coat  of  arteries,  and  indirectly  the  cardiac  muscle,  and  thus  im- 
proving nutrition  of  nerve-centres  (British  Medical  Journal,  i.,  1876). 


136  MATER1A    MEDICA    AND    THEEAPEUTICS. 

pheral  nerves  to  the  abdominal  sympathetic,  and  may  cause  nausea,  faint- 
ness,  actual  syncope,  and  in  some  cases  even  death.  Draughts  of  warm 
water,  if  not  rejected  by  the  stomach,  act  more  quickly  than  cold  upon  the 
skin  and  the  kidneys;  they  usually  cause  or  assist  vomiting,  but  if  a  pint 
or  more  be  taken  it  will  often  stop  vomiting  by  distending  and  paralyzing 
the  stomach.  I  have  also  known  even  a  moderate  quantity  of  hot  water 
stay  vomiting  when  ice  had  failed  to  do  so;  and  again,  a  small  quantity 
— two  or  three  teaspoonfuls  —  of  quite  hot  water,  taken  at  short  intervals, 
has  arrested  reflex  vomiting,  e.g.,  after  ovariotomy. 

A  certain  amount  of  fluid  taken  with  meals  assists  digestion,  but  too 
much  impairs  it  by  over-diluting  the  gastric  juice,  and  hurrying  on  the 
passage  of  the  food.  Its  temperature  is  of  importance,  for  if  taken  hot, 
especially  with  a  substantial  meal,  it  is  liable  to  distend  and  enfeeble  the 
stomach,  while  if  iced,  it  does  harm  by  contracting  capillaries  and  dimin- 
ishing normal  blood-supply,  although,  indeed,  a  healthy  stomach  will  tol- 
erate, for  a  time  at  least,  these  and  many  other  injurious  things.  Warm 
liquid,  such  as  tea,  taken  shortly  before  a  substantial  dinner,  will  com- 
monly disorder  the  digestive  functions  sooner  or  later,  but  this  is  not 
wholly  due  to  the  fluid,  but  to  its  astringency,  etc.,  for  a  warm  nutritious 
soup  at  the  commencement  of  a  meal  suits  many  persons.  If  they  are 
fatigued,  it  supplies  nourishment  in  a  form  which  is  readily  taken  up,  and 
enables  solid  food  to  be  better  digested. 

Taken  later  on  in  the  meal,  at  the  end,  or  an  hour  or  so  afterwards, 
fluids,  cold  or  warm,  materially  assist  completion  of  the  digestive  process, 
and  the  onward  passage  of  peptones  and  the  other  contents  of  the  stom- 
ach. 

It  is  well  known  that  water  exerts  a  marked  influence  on  the  fermen- 
tative process:  thus  sugar,  anhydrous  or  mixed  with  but  little  water,  does 
not  ferment  at  all;  with  moderate  amounts  of  water  the  vinous,  and  with 
an  excess  of  water  the  acetous  fermentation  takes  place,  and  it  is  very 
probable  that  water  exerts  analogous  influences  on  the  food.  Bacteria 
will  not  develop  in  a  concentrated  solution  of  albumen. 

THERAPEUTICAL  ACTIOX  (EXTERNAL). — Hemorrhage. — The  application 
of  iced  or  cold  water  is  an  old,  and  commonly  an  efficient  method  of  re- 
straining hemorrhage  from  small  vessels.  The  jet  of  water,  or  the  soaked 
•cloth  or  sponge  should  be  applied  suddenly  for  a  few  moments  at  a  time. 
Mr.  C.  B.  Keetley  has  lately  drawn  attention  to  the  value  of  hot  water  as 
a  haemostatic,  and  quotes  a  case  of  thigh-amputation,  where  a  sudden 
drenching  with  water  at  120°  F.  stopped  the  bleeding  after  cold  water 
had  failed  to  do  so.  He  suggests  that  in  such  cases  it  acts  as  an  excitant 
to  the  nerves  of  the  small  vessels,  and  perhaps  directly  irritates  the  muscles 
themselves  (Practitioner,  February,  1879).  Dr.  Paul  Brown  found  water 
at  150°  F.  succeed  well  in  staying  hemorrhage  after  an  amputation  when 
Esmarch's  bandage  was  removed  (Medical  Record,  1879). 


WATER.  137 

Mr.  Keetley  has  also  found  hot  water  efficacious  in  epistaxis,  though 
he  acknowledges  that  "  it  is  powerless  against  it  if  of  a  certain  grade  of 
severity,"  and  I  have  myself  seen  its  use  in  a  very  severe  case  followed 
by  serious  results.  During  one  attack  the  attendant  had  applied  it  for 
some  time,  though  the  bleeding  continued,  and  the  patient  became  alarm- 
ingly prostrate.  I  stayed  the  flow  quickly  with  cold  water,  but  in  a  second 
attack,  some  weeks  afterward,  I  heard  the  hot  water  treatment  was  again 
employed,  and  the  patient  died  of  syncope. 

In  Uterine  Hemorrhage  the  results  of  hot  water  injections  have  been 
more  satisfactory.  Windelband  used  it  at  117°,  120°,  124°  F.  (Medical 
Times,  1876).  Emmet  (New  York)  and  Whitwell  found  it  very  safe, 
efficient,  and  disinfectant  in  post-partum  hemorrhage  (Lancet,  i.,  1878,  p. 
920).  Lombe  Atthilluses  it  constantly  (at  110°  F.)  in  his  practice  at  the 
Rotunda,  not  only  in  hemorrhage,  but  also  in  chronic  uterine  congestions. 
Ricord  finds  a  hot  uterine  douche,  122°  F.,  "  almost  infallible  "  in  menor- 
rhagia.  C.  Richter  uses  hot  douches  for  hemorrhage  in  childbed,  and  re- 
ports 105  cases  occurring  in  the  Charite  (Berlin)  where  they  had  been 
employed  with  excellent  results;  he  recommends  injections  of  three  to 
five  pints  at  122°  F.  into  the  uterine  cavity  through  a  catheter,  and  for 
the  sake  of  disinfection  adds  a  proportion  of  1  per  cent,  of  carbolic  acid; 
he  says  that  the  hot  water  coming  in  continued  contact  with  the  inner 
surface  of  the  uterus  causes  a  soaking  and  swelling  of  the  tissues,  partic- 
ularly of  the  peri-vascular  connective  tissue,  and  thus  checks  the  hemor- 
rhage (Zeitschrift  fur  Geburtshiilfe  und  Gyncecologie). 

Peter  recommends  it  for  cases  of  non-puerperal  hemorrhage;  his  theory 
is  that  through  the  irritation  of  the  lumbar  ganglia  the  vaso-motor  nerves 
get  into  a  state  of  "  over-activity,"  and  that  the  vessels  contract  accord- 
ingly  (Centralblatt  fur  Gyncecologie).  I  have  myself  ordered  hot  water 
injections  in  several  cases  of  uterine  hemorrhage,  directing  a  stream  at 
122°  F.  into  the  uterine  cavity,  and  the  effects  have  been  various.  When 
hemorrhage  arose  from  cancer,  sometimes  there  was  immediate  relief, 
which  lasted  for  some  days,  but  in  others  the  bleeding  was  increased; 
when  the  bleeding  arose  from  a  retained  portion  of  the  placenta  a  larger 
flow  occurred;  when  caused  by  an  atonic  state  of  the  uterus  the  hot 
water  injection  alone  did  little  good,  but  when  alternated  with  cold  in- 
jections, 60°  to  70°  F.,  the  result  was  excellent.  In  all  other  cases  of 
hemorrhage  the  effect  was  beneficial.  I  am  satisfied  that  the  water 
should  be  as  hot  as  possible,  otherwise  success  cannot  be  secured;  and  I 
agree  with  Runge  in  calling  it  "  a  non-infallible  but  an  important  reme- 
dy." It  is  already  largely  used  in  London  practice,  with  very  general 
satisfaction.  Hot  water  bags  applied  to  the  lower  part  of  the  spine  also 
prove  useful  in  uterine  hemorrhage. 

Ulcers,   Wounds,    Contusions,  etc. — The  "cold  water  dressing,"  with 
wet  lint  cut  accurately  to  an  ulcerated  surface,  or  amply  covering  .an  in- 


138  MATEKIA    MEDICA    AND    THERAPEUTICS. 

flamed  part  and  overlapped  by  oiled  silk  or  gutta-percha  is  one  of  the 
best,  as  it  is  the  simplest,  application  for  ordinary  cases.  In  abscess, 
warm  fomentations  expedite  the  pointing  and  relieve  tension,  pain,  and 
other  symptoms.  They  are  useful  in  encouraging  bleeding  from  leech- 
bites,  etc.,  and  in  assisting  the  separation  of  sloughs.  In  more  severe 
wounds,  if  there  be  much  heat  and  irritation,  it  is  well  to  keep  the  dress- 
ing constantly  moist,  uncovered  by  waterproof,  and  the  most  complete 
method  of  doing  this  is  by  irrigation  from  a  can  of  water  over  the  bed — 
a  small  stream  percolating  the  dressings,  and  draining  into  a  basin  on  the 
floor.  On  the  other  hand,  sometimes,  the  cold  water  treatment  of 
wounds  is  too  depressing,  and  leads  to  slowness  of  repair,  or  sloughing, 
and  the  hot  water  dressing  or  immersion  has  been  recommended  in  such 
cases,  especially  by  Professor  Hamilton  (New  York)  and  some  other 
American  surgeons.  If  recent  lacerated  or  incised  wounds  of  unhealthy 
character  are  kept  constantly  under  hot  water  (95°  to  100°  F.),  there  is  a 
sense  of  comfort  induced,  not  absolute  relief  from  pain.  On  the  second 
or  third  day,  the  parts  adjacent  are  swollen,  but  not  much  reddened;  the 
integument  is  sodden  and  white.  On  the  fifth  day,  or  later,  the  swelling 
is  sometimes  great,  and  the  granulations  covered  with  a  white  exudation, 
but  the  area  of  acute  inflammation  is  much  limited;  erysipelas  and  gan- 
grene are  arrested  or  restrained;  traumatic  fever  has  seldom,  and  septi- 
caemia has  never  occurred  in  any  case  in  which  submersion  has  been  prac- 
tised from  the  first  day  (New  York  Medical  Record,  May,  1874).  Of 
course,  simple  incised  wounds  and  healthy  amputations  do  not  need  such 
an  elaborate  method  of  treatment. 

Hot  water  is  very  useful  in  the  treatment  of  recent  sprains,  the 
affected  limb  being  immersed  in  it  at  the  highest  endurable  temperature 
for  about  fifteen  minutes  (Medical  Record,  1879). 

For  JBurns,  Cellulitis,  Sloughing,  Phaged&na,  Sloughing  and  Pha- 
gedcenic  Chancres,  immersion  in  the  hot  bath  is  extremely  efficacious,  re- 
lieving pain,  limiting  the  disease,  hastening  separation  of  the  sloughs, 
cleansing  the  wound,  etc. 

Hernia. — A  bag  of  pounded  ice  placed  over  a  hernial  protrusion  has 
caused  its  reduction;  the  cold  lessens  the  volume  of  the  contents  of  the 
gut,  especially  of  the  gases;  it  also  stimulates  peristalsis,  and  causes  con- 
traction of  vessels. 

Heat  also  is  used  for  hernia  by  fomentation,  or  better,  by  the  hot 
bath.  It  relieves  pain,  allays  spasm  of  muscles,  and  so  favors  reduction: 
the  taxis  should  be  employed  while  the  patient  is  in  the  hot  bath,  which 
should  be  continued  until  muscular  relaxation  is  complete. 

Stricture — Retention  of  Urine. — A  lump  of  ice  introduced  into  the 
rectum  is  a  favorite  remedy  for  retention  of  urine.  Immersion  in  a  hot 
bath,  by  relieving  deep  congestion  and  allaying  muscular  spasm,  is  very 
useful  in  similar  retention,  especially  when  due  to  congestive  or  spas- 


WATER.  139 

modic  stricture,  or  to  either  of  these  conditions,  added  to  organic  stricture. 
The  application  of  a  hot  sponge  or  fomentation  to  the  genitals  and  hypo- 
gastrium  is  the  simplest  way  of  relieving  "  nervous"  retention. 

In  Orchitis,  iced  water  made  to  circulate  through  a  tube  coiled  round 
the  affected  testis  will  often  relieve  pain  instantly,  and  entirely  cut  short 
the  attack.  It  should  be  applied  early.  A  similar  coil  applied  to  the 
penis  has  been  introduced  by  Dr.  Otis  for  the  treatment  of  hemorrhage 
from  the  urethra  after  internal  urethrotomy. 

Jiubo — Haemorrhoids. — In  these  maladies  also  the  application  of  ice 
or  cold  water  is  often  serviceable.  At  other  times  hot  fomentation  gives 
more  relief,  as  it  may  do  in  orchitis. 

Varicocele. — Suspending  the  scrotum  in  cold  water  night  and  morn- 
ing, braces  up  the  dartos  and  the  muscular  tissue  in  the  veins,  and  re- 
lieves this  malady. 

Vesicat  Catarrh. — Warm  hip-baths  are  of  much  value  in  this  condi- 
tion, and  may  be  employed  two  or  three  times  daily,  for  half  an  hour  or 
an  hour  at  a  time.  In  gonorrhceal  inflammations  and  discharges  they 
are  also  good. 

Catarrh. — In  frequently  recurrent  attacks  of  this  affection — "  always 
catching  cold  " — a  condition  generally  dependent  on  impaired  nerve-power 
and  over-sensitive  skin,  the  Turkish  bath  proves  very  useful;  but  when 
inadmissible  for  any  reason,  simple  cold  wet-towel  friction  in  the  morning 
should  be  substituted. 

Tonsillitis — Diphtheria. — Thick  compresses  wrung  out  of  cold  water, 
applied  to  the  throat  and  covered  with  flannel,  usually  give  much  relief, 
but  sometimes  answer  better  when  soaked  in  very  hot  water  (112°  F.) 
and  applied  over  the  front  part  of  the  neck  and  chest,  covered  with  flan- 
nel and  oiled  silk,  and  renewed  every  four  to  six  hours. 

Croup. — In  true  inflammatory  croup,  a  very  hot  compress  or  sponge 
and  steam-inhalation  are  especially  to  be  recommended,  and  having  been 
satisfied  with  these  I  have  not  often  used  the  cold  applications  recom- 
mended by  some  authors. 

In  Spasmodic  Croup,  however,  a  cold  wet  cloth  to  the  back  of  the 
neck  and  the  larynx  during  the  attack,  and  douching  the  spine  or  the 
whole  body  once  or  twice  daily,  is  an  effective  treatment. 

Thoracic  Inflammations. — Niemeyer  and  other  high  authorities,  chief- 
ly German,  have  strongly  advised  continuous  cold  applications  in  the 
early  stages  of  thoracic  inflammation,  both  pleuritic  and  pneumonic,  plac- 
ing compresses  over  the  affected  side,  and  changing  them  frequently: 
they  now  even  prefer  the  ice-bag  in  such  cases.  In  English  practice, 
however,  this  method  is  still  regarded  as  involving  unnecessary  risk,  and 
it  has  not  been  generally  adopted. 

Phthisis  Pulmonalis. — The  cold  douche  is  used  externally  in  phthisis, 
chiefly  in  Gdrbersdorf  and  Davos.  It  is  only  suitable  for  cases  where 


140  MATERIA    MEDICA    AND    THERAPEUTICS. 

the  temperature  of  the  body  is  normal,  and  the  disease  not  actively  pro- 
gressing, and  should  be  employed  with  the  greatest  care  and  under  medi- 
cal supervision.  The  patient  at  first  is  rubbed  with  dry  towels,  and  then, 
on  being  made  to  take  a  deep  inspiration,  is  exposed  to  the  cold  douche 
for  five  seconds — by  degrees  the  duration  of  the  douche  may  be  prolonged, 
if  desirable,  to  forty-five  or  sixty  seconds — immediately  after,  the  body 
is  dry -rubbed  until  the  skin  gets  red  and  warm;  the  patient  is  then  dressed, 
and  active  exercise,  such  as  walking  uphill,  completes  the  process.  An- 
semic  patients  cannot  bear  the  douche  for  more  than  five  or  ten  seconds. 
When  this  treatment  can  be  borne,  it  promotes  appetite  and  digestion, 
and  renders  the  patient  less  susceptible  to  the  injurious  influences  of  a 
changeable  climate. 

Fevers. — The  application  of  water  to  the  treatment  of  these  disorders 
is  one  of  the  most  important  results  of  modern  therapeutics — or 'rather 
of  a  revival  of,  and  improvement  upon,  older  ideas,  for  it  is  not  wholly 
modern.  Wright  and  Currie  adopted  it  in  1786-1796,  using  cold  effusion, 
i.e.,  dashing  several  buckets  of  water  over  the  patient  when  stripped. 
The  latter  physician  records  an  epidemic  of  typhus  fever  affecting  58  sol- 
diers, most  of  them  severely:  56  were  treated  by  cold  salt-water  effusion, 
and  all  recovered;  the  other  2,  considered  too  weak  for  this  treatment, 
were  the  only  fatal  cases.  He  traced  an  evening  exacerbation,  and  insist- 
ed on  the  importance  of  using  the  remedy  during  this  access:  or  at  least 
during  a  period  of  great  heat,  and  not  during  a  rigor,  nor  during  a  pro- 
fuse perspiration  ("  Medical  Reports  on  the  Effects  of  Water,"  London, 
1798).  His  method  of  treatment,  although  valuable  and  successful,  was 
too  harsh  for  ordinary  use;  but  soon  after  his  observations,  Giannini,  of 
Milan,  advocated  immersion  in  cold  water  for  two  to  fifteen  minutes  in 
all  forms  of  fever  (especially  intermittent,  petechial,  rheumatic,  and  scar- 
let fevers);  he  drew  up  very  judicious  rules  for  practice,  and  he  had  very 
good  success,  but  he  objected  to  the  use  of  ice  ("Delia  natura  delle  feb- 
bri,"  Milano,  1805).  Frohlich  (1822)  was  one  of  the  first  to  regulate  his 
practice  of  cold  or  tepid  bathing  by  the  thermometer.  An  account  of 
his  and  many  other  earlier  observations  has  been  given  by  Fleury 
("Traittj  d'Hydrotherapie,"  Paris,  1866).  In  our  own  time,  Ziemssen 
has  improved  upon  the  older  methods,  by  his  process  of  gently  lowering 
the  patient  (with  a  sheet)  into  a  bath  at  a  temperature  of  about  98°  F., 
and  then  gradually  cooling  it  by  addition  of  cold  water  or  ice  to  80°  or 
72°  F.,  or  even  lower,  according  to  the  effect  produced;  this  should  be 
noted  by  a  thermometer  (placed  in  the  rectum  if  possible).  When  a  dis- 
tinct reduction  of  the  fever  heat  is  evident  (it  may  be  in  five  minutes  or 
in  thirty),  the  patient  is  dried,  and  laid  again  in  bed,  and  the  process  may 
be  repeated  two  to  six  times  daily.  A  less  complete  mode  of  attaining  a 
similar  result  is  by  cold  compresses  to  the  trunk,  ice-bags  to  the  spine 
and  other  parts,  injections  of  iced  water  into  the  rectum,  or  the  wet-sheet 


WATER.  141 

pack.  All  such  applications,  valuable  as  they  are,  must  be  carefully- 
watched:  they  depress  the  circulation,  sometimes  extremely,  and  may 
need,  after  their  use,  stimulants  internally,  and  hot  cloths  and  bottles  ex- 
ternally, in  order  to  relieve  too-cold  extremities,  blue  lips,  and  tendency 
to  collapse.  The  bath  generally  used  in  Germany  has  a  temperature  of 
about  70°  F.,  or  somewhat  lower,  and  the  patient  is  kept  in  it  for  about 
ten  minutes,  but  very  weak  subjects  only  from  five  to  seven  minutes. 
Ziemssen  now  uses  this  bath,  I  believe,  more  frequently  than  the  gradually 
cooled  one,  mostly  mentioned  with  his  name. 

Hyper-pyrexia. — According  to  general,  though  not  universal  experi- 
ence, a  rise  of  temperature  above  108°  F.  is  quickly  fatal,  and  a  range 
between  105°  and  112°,  which  may  occur  in  acute  rheumatism,  etc.,  has 
been  specially  termed  "  hyper-pyrexia."  Under  the  systematic  use  of 
cold  applications,  some  remarkable  recoveries  from  this  critical  condition 
have  taken  place,  and  two  cases  fully  reported  by  Dr.  Wilson  Fox  at- 
tracted much  professional  attention  to  the  subject.  They  were  both 
cases  of  rheumatic  fever  with  cardiac  complications:  one,  a  woman  of 
forty-nine,  was  lowered  at  9.50  P.M.  into  a  bath  at  96°,  when  her  temper- 
ature was  109.1°  F.  She  was  unconscious,  the  pulse  imperceptible,  the 
face  cyanotic,  the  respiration  irregular  and  gasping.  At  9.55  P.M.,  the 
rectal  temperature  was  110°.  "  Ice  was  fetched,  a  large  lump  was  placed 
on  her  chest,  another  on  her  abdomen,  a  bag  filled  with  ice  was  tied 
down  the  length  of  the  spine,  and  while  two  assistants  bailed  the  warmer 
water  out  of  the  bath,  two  others  poured  ice-water,  as  rapidly  as  the  pails 
could  be  filled,  over  the  patient."  At  10.10  P.M.,  temperature  was  109.1°; 
at  10.25  P.M.  it  was  106°;  the  pulse  now  became  perceptible  (140),  and 
the  patient  showed  signs  of  consciousness.  Brandy  was  freely  given. 
At  10.35  P.M.  the  temperature  was  103.6°  F.,  and  the  patient  was  taken 
out  of  the  bath.  At  10.55  the  temperature  was  100.6°  F.,  lividity  had  dis- 
appeared, the  patient  could  speak,  and  had  a  certain  imperfect  conscious- 
ness; the  temperature  continued  to  fall,  till  at  11.25  P.M.  it  was  at  97.4° 
(vagina),  and  hot  applications  and  an  enema  of  brandy  were  required  to 
prevent  collapse.  Another  bath  was  given  next  day,  when  the  body 
temperature  had  risen  to  104.5°  F.,  the  bath  was  at  64°  F.,  and  was  con- 
tinued for  twenty  minutes;  on  removal,  the  patient's  temperature  was 
103.9°,  and  it  continued  to  fall  for  forty  minutes  longer  till  it  reached 
99.4°.  Rigors  occurred,  and  hot  applications  were  again  required.  From 
this  time,  the  cold  treatment  was  continued  by  ice-bags  to  the  spine, 
which  sometimes  were  effective  in  reducing  the  body  heat,  and  sometimes 
not,  but  within  a  week  from  the  baths,  the  patient  was  sitting  up  conva- 
lescent, and  within  a  month  was  able  to  travel. 

The  second  case  presented  more  difficulties,  and  required  a  longer 
treatment:  it  occurred  in  a  man  aged  thirty-six,  suffering  from  double 
pneumonia,  double  pleuritis,  and  pericardial  effusion.  On  the  seven- 


142  MATERIA    MEDIC  A    AND    THERAPEUTICS. 

teenth  day  of  his  disease,  the  temperature  rising  rapidly  to  107°  F.,  and 
delirium  setting  in,  he  was  placed  in  a  bath  at  89°  F.,  which  was  cooled 
to  86°.  The  after-effect  of  this  was  a  fall  of  body  temperature  to  98°, 
and  return  of  consciousness.  For  eight'days  cold  applications  were  kept 
up  almost  continuously;  eight  baths  were  given,  of  duration  varying 
from  twenty-five  minutes  to  seventy  minutes,  and  in  the  intervals,  the 
ice-bag  or  wet-pack  was  used,  the  object  being  to  keep  the  temperature 
under  103°  F.  at  least.  This  patient  also  made  a  good  recovery,  but  the 
temperature  did  not  remain  normal  until  thirty-one  days  after  this  treat- 
ment was  commenced  (Lancet,  ii.,  1871). 

Shortly  before  these  cases,  Dr.  Meding,  treating  rheumatic  hyper-py- 
rexia  in  a  female,  aged  twenty-two,  with  enemata  of  iced  water  every  half- 
hour,  and  the  application  of  iced  cold  cloths,  reduced  the  temperature  in 
five  hours  from  108.6°  to  99.5°  F.,  and  the  pulse  from  140  to  72;  no  fur- 
ther rise  ensued,  and  no  relapse. 

Of  course,  all  cases  have  not  been  so  successful,  and  Dr.  Fox  refers  to 
several  that  ended  badly;  yet  those  quoted  are  sufficient  to  show  the  im- 
mense power  of  this  mode  of  treatment,  and  it  has,  since  that  time,  been 
fully  endorsed  by  many  English  authorities.  Dr.  Anstie  especially  pressed 
its  adoption,  and  Dr.  Waters  (Liverpool)  has  recently  given  good  illustra- 
tions of  its  value  in  two  cases  of  rheumatic  fever,  one  with  pericarditis, 
and  both  reaching  a  temperature  of  106.7°  F.,  and  treated  by  baths  at 
95°  to  100°,  cooled  to  70°,  and  sometimes  lower  (British  Medical  Journal, 
i.,  1878).  In  a  careful  paper,  Dr.  Ord  has  given  details  of  the  use  of 
graduated  cold  baths  in  ten  cases  of  hyper-pyrexia,  of  which  two  were 
fatal  (one  of  these  had  only  one  bath,  and  died  eleven  days  afterward  of 
lung-congestion).  In  several  of  the  cases,  relief  to  nerve-excitement,  and 
even  to  bronchial  and  congestive  lung-condition,  as  well  as  to  pyrexia, 
was  marked;  six  was  the  largest  number  of  baths  given  in  any  one  case. 
The  only  contra-indication  is  excessive  weakness.  Dr.  Ord  advocates  the 
systematic  early  use  of  this  treatment,  but  also  points  out  the  difficul- 
ties in  thoroughly  carrying  it  out  ("St.  Thomas's  Hospital  Report," 
1879). 

Acute  Rheumatism. — I  have  often  given  the  greatest  relief  in  an 
ordinary  but  severe  attack,  with  pain  in  all  joints,  sweating,  pyrexia,  etc., 
by  means  of  a  hot  blanket-pack,  the  patient  being  enveloped  in  one  blanket 
wrung  out  of  hot  water,  and  then  covered  with  several  others,  and  left 
thus  for  half  an  hour  or  more.  Dr.  Dowse  has  made  scientific  observa- 
tions on  this  form  of  bath,  and  reported  much  benefit  from  it  (British 
Medical  Journal,  i.,  1875).  In  the  blanket-pack  he  found  temperature 
rise  one  to  two  degrees,  and  at  the  same  time  much  sweating  produced. 
He  continued  it  for  six  hours  at  first,  afterward  for  one  or  two  hours 
only;  brandy  was  sometimes  required  for  depression.  He  did  not  use 
this  bath  when  the  body-temperature  was  over  104°  F.,  or  the  patient 


WATER.  143 

very  prostrate,  nor  when  the  aortic  valves  were  incompetent.  In  chronic 
gout  and  rheumatism  the  Turkish  bath  is  especially  useful. 

Puerperal  Fever. — In  a  very  striking  case  reported  by  Dr.  W.  S.  Play- 
fair,  a  sheet  or  towels  wrung  from  iced  water  were  almost  constantly 
applied  for  eleven  days,  the  patient  lying  on  a  water-bed  kept  cold  with 
running  water,  and  having  an  ice-cap  on  the  head.  By  these  means  only 
could  the  temperature  be  kept  under  105°.  Eventually  the  patient  was 
saved,  Warburg's  tincture  having  some  share  in  the  result  (British  Med- 
ical Journal,  ii.,  1877).  Dr.  Wiltshire  has  also  reported  cases  of  this 
disease  treated  by  dry  cold,  i.e.,  ide  packed  in  bottles  and  tins  near  the 
patient,  with  temporary  good  result  under  unfavorable  conditions.  Mr. 
Knowsley  Thornton  has  found  an  ice-cap,  for  application  to  the  head 
only,  very  useful  in  keeping  down  the  temperature  for  ovariotomy. 

Typhoid  Fever. — Liebermeister,  at  Basle,  systematized  the  treatment 
of  typhoid  fever  by  cold  baths,  and  his  records  show  a  lowering  of  mor- 
tality from  26  per  cent,  to  7  per  cent.  So  soon  as  the  disease  was  de- 
clared, usually  about  the  ninth  day,  the  treatment  was  commenced  with 
a  bath  at  68°  F.  for  ten  minutes;  this  was  repeated,  not  at  a  fixed  time, 
but  so  often  as  the  temperature  (taken  every  two  or  three  hours)  rose 
above  102°  F.  Sometimes  six  or  seven  baths  were  given  in  twenty-four 
hours,  but  commonly  a  less  number.  When  they  acted  best  an  early  re- 
mission of  pyrexia  occurred,  and  lasted  for  a  long  period.  Quinine  in 
full  doses,  or  digitalis,  were  often  combined  with  this  treatment.  Surgen- 
sen  followed  similar  practice,  and  also  Bartels,  who  claimed  to  reduce  his 
mortality  to  3  per  cent.  There  can  be  no  doubt  that  excellent  results 
may  be  shown  by  these  physicians,  yet  the  risk  pf  movement  and  disturb- 
ance in  cases  with  serious  intestinal  lesion  must  not  be  ignored,  and  in 
the  majority  of  instances  other  treatment  will  answer  every  indication. 

Remittent  Fever. — A  similar  method  of  systematic  bathing  has  been 
followed  with  advantage  in  the  remittent  fever  of  the  tropics,  and  Dr. 
Lucas  has  recently  described  a  severe  case  in  which  the  patient  (at  103° 
F.)  was  lowered  into  a  bath  at  80°,  and  a  small  continuous  stream  of  cold 
water  was  poured  over  the  body  for  eight  minutes.  After  return  to  bed 
the  temperature  was  97°;  quinine  and  port  wine  were  given.  After  seven 
days  of  bathing — the  temperature  being  kept  under  103° — some  bron- 
chitis having  developed,  injections  of  cold  water  into  the  rectum  were 
substituted  for  the  bath,  and  with  very  definite  effect  in  lowering  tem- 
perature; recovery  occurred  in  about  a  month  (Medical  Times,  ii.,  1879). 
In  intermittent  fever,  both  Currie  and  Gianniui  used  cold  affusion  and 
bathing  with  excellent  effect,  and  found  that  it  prevented  or  delayed  a 
paroxysm  if  given  an  hour  before  its  usual  access;  also  that  the  water- 
treatment  much  assisted  the  action  of  quinine.  Dr.  Fleury,  however, 
claims  for  his  cold  douche  much  more  than  this,  stating  that  he  has 
radically  cured  by  it  more  than  one  hundred  cases  of  all  forms  of  inter- 


144  MATEEIA    MEDICA    AND    THERAPEUTICS. 

mittent  fever,  many  of  them  rebellious  to  all  ordinary  treatment  (includ- 
ing quinine,  arsenic,  change  of  climate,  etc.),  and  he  quotes  evidence  on 
the  subject  which  should  receive  earnest  attention.  An  energetic  cold 
douche  for  fifteen  or  twenty  seconds  can  relieve  both  the  pyretic  and  the 
congestive,  and  also  the  anaemic  condition.  For  preventing  a  paroxysm 
it  should  be  used  a  quarter  of  an  hour  before  the  expected  onset;  if  this 
come  on  before  its  time,  the  douche  may  even  be  used  in  the  cold  stage 
with  good  effect,  if  given  strongly  for  a  short  time  so  as  to  be  excitant; 
if  necessary,  a  second  may  be  given  in  the  hot  stage.  In  irregular  inter- 
mittents  the  abdominal  viscera  are  usually  congested,  and  Fleury  finds 
the  douche  competent  to  reduce  both  liver  and  spleen  to  their  normal 
size  in  comparatively  short  time.  Cerebral  complications  require  com- 
presses; pulmonary  oadema  and  acute  bronchitis  contra-indicate  the  treat- 
ment. In  bilious  subjects  purgatives  may  be  required,  or  other  treatment 
conjoined. 

Scarlatina. — In  this  fever,  some  of  the  very  best  results  of  cold  bath- 
ing and  packing  have  been  obtained.  In  mild  cases,  tepid  or  cold  spong- 
ing during  the  course  of  the  disorder,  and  a  few  carbolized  warm  baths 
at  the  termination  are  all  that  is  necessary.  The  warm  baths  during  the 
period  of  desquamation  help  the  process,  and  give  much  comfort  to  the 
patient,  especially  if  followed  by  inunction  of  carbolized  oil  or  glycerin. 
They  also  stimulate  the  action  of  the  skin,  and  lessen  renal  congestion,  or 
the  risk  of  it,  and  also  the  chance  of  infecting  other  persons. 

Dr.  Vaudrey  Lush,  indeed,  and  some  other  physicians,  have  advocated 
the  routine  use  of  the  warm  bath  from  three  to  five  minutes,  at  first  three 
times  a  day,  afterward  less  often,  for  every  case  of  the  malady  (Lancet, 
ii.,  1880);  but  without  denying  the  advantages  of  this  method,  it  is 
clearly  often  impracticable,  and  cannot  be  considered  necessary. 

•  In  very  severe  cases,  however,  when  the  temperature  rises  to  104°, 
105°,  or  106°,  F.,  and  there  is  delirium  or  stupor,  the  rash  being  dark  and 
indistinct,  and  the  urine  scanty  and  albuminous,  I  have  frequently  seen, 
even  in  apparently  hopeless  conditions,  the  cold  or  hot  wet  pack  bring 
out  a  vivid  rash,  and  cause  lowering  of  temperature  and  abatement  of  all 
severe  symptoms.1  Dr.  Edison  has  reported  two  illustrations  of  this,  oc- 
curring in  children,  with  delirium,  etc.,  and  both  successfully  treated  by 
frequent  bathing  (Lancet,  1877);  interesting  cases  treated  by  cold 
affusion,  also  valuable  cautions  on  the  subject  may  be  found  in  Trous- 
seau's "  Clinical  Lectures  "  (vol.  ii.). 


1  Although,  as  above  stated,  temperature  is  commonly  reduced  in  the  pack,  I  have 
known  it  rise  2°  to  3°  F.  in  five  different  patients  in  the  cold  pack,  and  in  four  others 
in  the  hot  pack.  At  one  time  I  thought  such  an  occurrence  to  contra-indicate  the 
treatment,  but  furhter  experience  has  shown  me  that  it  does  not  do  so,  and  I  believe 
that  even  in  the  nine  cases  referred  to,  recovery  was  assisted  by  the  treatment. 


WATER.  145 

*  I  first  used  the  hot  pack  in  a  case  of  suppressed  scarlatina  (where  the 
prejudices  of  parents  prevented  the  usual  cold  applications),  and  finding 
the  results  equally  good,  I  have  commonly  adopted  it.  In  the  case  of  a 
boy  whom  I  found  convulsed,  and  with  dusky  purplish  skin,  on  the  third 
day  of  what  was  presumed  to  be  scarlatina,  the  hot  sheet  acted  ad- 
mirably. The  throat  was  much  affected,  albumen  was  in  the  urine,  and 
consciousness  was  lost.  Within  half  an  hour  of  commencing  the  hot 
pack  he  was  able  to  speak,  perspired  freely,  and  the  rash  came  out  a  vivid 
red;  he  was  afterward  put  in  blankets,  and  went  on  perfectly  well  with- 
out the  necessity  of  repeating  the  pack.  In  another  still  more  severe 
case,  the  convulsions  had  lasted  over  two  days,  the  child  was  quite  blue, 
there  was  albumen  in  the  urine,  and  his  life  was  despaired  of;  but  in  the 
first  pack  consciousness  returned,  and  recovery  followed. 

The  vapor-bath  is  another  mode  of  affecting  the  same  results,  and  is 
especially  applicable  when  renal  congestion  and  albuminuria  are  marked, 
and  in  such  cases  compresses,  poultices,  or  fomentations  should  be  kept 
applied  over  the  loins.  The  instances  given  will  suffice  to  show  the  power 
of  this  treatment,  although  certainly  there  are  cases  of  malignant  scarlet 
fever  which  no  art  can  save. 

For  the  sore  throat  of  scarlatina,  compresses  should  be  used  exter- 
nally. I  find  it  best  to  have  the  throat  bathed  with  water  as  hot  as  can 
be  borne,  for  about  five  minutes  every  three  or  four  hours,  and  directly 
afterward  a  bandage,  wrung  out  of  water  at  about  112°  F.,  should  be 
applied  round  the  neck  and  covered  with  oiled  silk.  This  should  be  con. 
tinued  for  three  or  four  days  as  an  adjunct  to  other  treatment.  Dr.  H. 
Corson  (U.  S.)  recommends  a  piece  of  ice,  in  gutta-percha,  over  each 
parotid  gland.  Warm  water  is  a  good  gargle,  or  ice  may  be  swallowed 
in  small  pieces  with  much  advantage. 

In  Measles,  Small-pox,  and  other  eruptive  disorders,  similar  treatment 
by  bathing  and  packing  is  valuable. 

Nephritis. — In  acute  nephritis  from  other  than  scarlatinal  causes, 
warm  packing  and  vapor-baths,  and  similar  means  of  inducing  diaphore- 
sis, are  almost  equally  valuable  for  relieving  the  renal  congestion  and 
eliminating  waste  products.  In  chronic  nephritis  they  act  specially  as 
eliminants,  and  they  also  lessen  dropsy. 

Hepatic  Congestion. — In  acute  cases,  hot  packing  over  the  liver,  and 
in  subacute  and  chronic  cases  hot  mustard-packing  and  a  course  of  Turk- 
ish baths,  are  highly  serviceable. 

Catarrhal  Jaundice. — Krull  has  written  to  advocate  the  treatment  of 
this  malady  by  the  slow  injection  into  the  bowel  of  30  to  70  oz.  of  water 
at  a  temperature  of  60°  to  72°.  This  may  be  practised  for  as  long  a  time, 
and  to  the  extent  that  the  patient  can  bear  it,  once  in  the-  day:  seldom 
more  than  seven  "  irrigations "  are  required.  They  are  said'  to  relieve 
gastric  troubles,  to  improve  appetite,  and  quickly  cause  the- reappearance 
VOL.  I.— 10 


146  MATERIA    MEDICA    AND    THERAPEUTICS. 

of  bile  in  the  stools.  The  increased  intestinal  peristalsis  is  presumed  -to 
induce  corresponding  contraction  in  the  biliary  passages. 

Typhlitis — Peritonitis. — The  application  of  an  ice-bag,  or  of  iced 
compresses,  in  these  conditions  has  often  proved  more  useful  than  the 
usual  orthodox  poultice,  and  in  early  stages,  the  local  inflammation  and 
the  general  pyrexial  state  may  both  be  relieved  by  local  cold.  On  the 
other  hand,  in  some  cases  a  prolonged  hot  sitz-bath,  or  smoking  hot  fo- 
mentations, renewed  about  every  half-hour,  give  great  relief.  The  nausea 
or  vomiting  is  often  quickly  checked  by  administering  small  quantities  of 
ice  or  iced  water;  at  other  times  by  hot  water. 

Diarrhcea. — The  abdominal  pain  of  acute  diarrhoea  is  soothed  by  com- 
presses, poultices,  or  warm  bathing.  In  children  some  care  is  required  as 
to  the  bath,  for  convulsions  have  occurred  on  placing  a  child  suffering 
from  diarrhoea  in  a  bath  at  98°  F.  This  was  most  likely  from  an  increase 
in  body-temperature  under  the  influence  of  external  heat  (Dr.  Haddon: 
Practitioner,  vol.  viii.).  The  child  ultimately  recovered,  but  in  such  a 
case  the  cold  sheet  would  probably  answer  better. 

Cold  applications  are  often  more  suitable  than  hot  ones  in  choleraic 
diarrhoea  (McKenna:  Lancet,  ii.,  1876),  and  I  agree  with  Messemer  in  the 
experience  that  cold  water  enemata  act  excellently  as  tonics  and  astrin- 
gents in  chronic  cases.  If  slowly  injected,  they  distend  and  keep  apart 
the  coats  of  the  bowel,  and  thus  save  irritation  (Medical  Record,  1878). 
I  have  followed  this  practice  for  many  years.  Wenzel,  an  experienced 
naval  surgeon,  recommends  injections  of  ice-cold  water  in  dysentery,  and 
has  found  recent  acute  cases  subside  quickly  under  this  without  other 
treatment.  Fleury  gives  some  remarkable  illustrations  of  chronic  dysen- 
tery and  diarrhoea  cured  by  the  systematic  use  of  the  cold  douche,  one 
patient,  aged  forty,  having  previously  used  many  medicinal  remedies 
under  able  physicians.  It  is  certainly  a  remedy  to  be  remembered  in  ob- 
stinate cases. 

Even  in  cholera  the  application  of  water,  warm  or  cold,  may  be  made 
highly  serviceable.  Trousseau  wrote  strongly  in  its  favor  when  prejudice 
against  it  was  greater  than  it  is  at  present.  The  stage  of  collapse  may 
be  controlled  by  a  hot  mustard  blanket-pack;  but,  as  a  rule,  more  perma- 
nent good  will  be  obtained  from  cold  applications.  Niemeyer  is  an  au- 
thority for  recommending  the  pack  with  iced  sheets  in  cholera  (Lancet, 
ii.,  1876,  p.  346),  and  Dr.  Chapman  has  offered  evidence  in  favor  of  ice- 
bags  to  the  spine. 

Skin  Diseases. — In  all  forms  of  dry,  scaly,  skin  disease  (whether  sy- 
philitic or  not)  warm  baths  (especially  when  made  emollient  and  alkaline) 
and  vapor-baths  are  useful.  In  acne,  hot  bathing  or  steaming  opens  up 
the  glands  and  relieves  congestion.  In  psoriasis,  ichthyosis,  lichen, 
prurigo,  "  pityriasis  rubra,"  and  chronic  dry  eczema  and  seborrhoea,  for 
removing  accumulated  secretion  or  preventing  contact  of  air,  water  com- 


WATER.  147 

presses  are  serviceable.  Hebra  has  tried  the  prolonged  warm  bath  for 
from  two  hours  to  nine  months  at  a  time,  in  some  such  cases,  and  in 
extensive  burns,  etc.,  and  has  ascertained  that  nutrition,  respiration,  and 
secretion  go  on  in  the  continued  bath  in  a  normal  manner  (Medical  Record, 
1877).  On  the  other  hand,  in  some  skins,  and  especially  when  the  epi- 
dermis is  removed,  as  it  commonly  is  in  acute  eczema,  water  is  apt  to 
excite  much  irritation. 

Cerebral  Congestion. — Cold  applied  to  the  head,  while  hot  mustard- 
water  is  used  to  the  feet,  is  one  of  the  simplest  modes  of  equalizing  the 
cerebral  circulation.  It  must,  however,  be  used  with  caution  where  cere- 
bral anasmia  is  readily  induced,  as  in  weakly  subjects.  Ice  to  the  nape 
of  the  neck  also  acts  well,  and  sometimes  the  alternate  use  of  cold  and 
hot  applications  gives  the  best  results.  This  is  especially  the  case  in  the 
congestion  of  opium-narcosis,  uraemia,  and  carbonic  acid  poisoning  (Bar- 
tholow). 

Meningitis. — In  cerebral  or  spinal  meningitis  the  application  of  ice  is 
a  valuable  resource,  but  if  the  face  be  pale,  and  there  be  tendency  to  chil- 
liness and  prostration,  it  is  not  suitable. 

Sunstroke — "  Thermic  Fever.'1'' — When  the  head  is  hot,  the  pupils 
contracted,  the  pulse  full,  and  the  temperature  high,  cold  packing  is  de- 
cidedly indicated,  also  cold  affusions,  especially  to  the  head. 

Delirium  Tremens. — When  the  symptoms  are  violent  and  acute,  with 
flushing  and  heat  of  head,  full  pulse,  and  much  restlessness,  a  cold  pack, 
or,  if  possible,  a  douche,  or  at  least  an  ice-bag  or  cold  compresses  to  the 
head,  may  be  very  useful  in  procuring  quiet,  and  even  sleep.  When 
much  depression  or  evidence  of  vascular  degeneration  exists,  such  treat- 
ment must  be  employed  with  extra  care. 

Insomnia. — This  is  'often  dependent  upon  functional  congestion  of 
the  nerve-centres,  and  is  amenable  to  different  applications  of  water. 
The  general  tepid  bath  is  suitable  for  children  especially.  A  cold  sitz- 
bath  relieves  after  intellectual  work,  or  even  a  cold  compress  of  a  folded 
wet  towel  placed  on  the  epigastrium,  and  covered  by  a  dry  towel,  is  often 
very  efficacious.  A  hot  mustard  foot-bath,  while  cold  is  applied  to  the 
head,  or  a  rapid  dipping  of  the  feet  in  cold  water  and  vigorous  friction 
afterward,  tend  to  the  same  result. 

Mental  Disorder — Melancholia. — So  valuable  is  the  douche-bath  in 
some  mental  cases  that  there  has  been  a  tendency  to  overdo  this  form  of 
treatment,  and  even  fatal  results  have  been  recorded  from  it  in  cases  of 
extreme  depression.  It  is  important  not  to  use  it  too  long  at  a  time. 
Ten  to  twenty  seconds  is  sufficient  for  melancholic  cases,  and  the  patient 
should  stand  in  warm  water,  so  as  to  secure  warmth  of  the  extremities. 
One  or  two  minutes  of  a  shower-bath,  should  suffice  for  excited  cases, 
and  often  a  prolonged  warm  bath  (thirty  minutes),  while  cold  is  applied 
to  the  head,  is  the  most  soothing  form  of  treatment.  The  Turkish-bath 


148  MATEKIA    MEDIC  A    AND    THERAPEUTICS. 

has  recently  been  introduced  into  asylums,  and  with  some  excellent  re- 
sults. 

Hypochondriasis. — A  course  of  cold-water  treatment,  which  is  at  first 
stimulating  and  afterward  soothing,  is  useful  in  this  affection.  It  gener- 
ally stimulates  the  vital  functions,  promotes  tissue-change  and  nutrition, 
invigorates  the  skin,  and  strengthens  the  physical  and  mental  condition. 
Other  kinds  of  treatment,  however,  are  often  more  successful. 

Impotence. — When  this  arises  from  excess,  cold  sitz-baths  and  spinal 
•washings  often  relieve. 

Convulsion. — The  reflex  convulsions  of  infancy  are  often  cut  short  by 
a  warm  bath,  cold  water  being  poured  on  the  head  at  the  same  time  (v. 
p.  146).  Hysterical  convulsion  is  sometimes  arrested  by  a  sudden  shock 
of  cold  to  the  surface,  and  a  daily  shower-bath  is  of  great  service  in  im- 
proving the  hysterical  state. 

In  Chorea  cold  affusion,  especially  over  the  spine,  is  very  beneficial. 

In  Urcemic  Convulsion,  this  treatment  is  not  so  markedly  effective, 
though  cold  to  the  head  is  advisable;  but  the  use  of  packing,  or  of  the 
vapor-bath,  so  soon  as  the  general  condition  admits,  is  often  of  the  great- 
est service. 

Tetanus. — Currie,  Giannini,  and  other  early  observers  record  benefit 
from  cold  applications  in  tetanus,  and  illustrations  of  it  have  been  pub- 
lished by  Dr.  W.  S.  Playfair  in  his  Indian  experience  (Medical  Times,  i., 
1862).  Of  three  severe  cases  of  acute  tetanus,  two  were  markedly  re- 
lieved by  the  application  of  ice  in  bladders  along  the  spine;  the  third  was 
considered  too  weak  for  a  treatment  which  is  in  itself  depressant,  and  this 
one  only  ended  fatally. 

Hydrophobia. — Free  action  of  the  skin  offers  one  of  the  best  hopes  in 
this  disease,  and  may  be  secured  by  means  of  the  Turkish  or  vapor-bath. 
Buisson,  a  French  physician,  has  recorded  that,  having  become  inoculated 
with  the  poison  of  rabies,  and  feeling  the  access  of  the  malady,  he  went 
into  a  hot  vapor-bath  (107°  F.)  with  the  intention  of  committing  suicide, 
but  found  his  symptoms  shortly  relieved,  and  by  a  course  of  such  baths 
(127°  to  140°  F.)  quite  cured.  He  adds  that  he  has  treated  many  similar 
cases  successfully  (Lancet,  ii.,  1877).  In  a  case  of  Mr.  Southam's,  which 
occurred  recently  at  the  Manchester  Infirmary,  a  girl  was  very  much  re- 
lieved of  severe  symptoms  while  in  a  "  lamp-bath  "  and  perspiring  freely, 
though  a  sudden  spasm  of  the  larynx  caused  her  death  some  hours  after- 
ward (Medical  Record,  October,  1879). 

Paraplegia. — In  cases  connected  with  functional  disorder  of  the  cord 
hot,  or  alternate  hot  and  cold  douches  to  the  spine  often  act  very  well. 
Paralyzed  limbs  that  have  become  cold  and  wasted  may  often  be  much  im- 
proved by  towel-packing  and  douches,  combined  with  vigorous  friction. 

Spinal  Pain. — The  sense  of  weakness  and  exhaustion  referred  especi- 
ally to  the  lower  part  of  the  spine,  occurring  in  delicate  subjects  after  over- 


WATER.  149 

exertion  of  any  kind,  and  due  probably  to  a  passive  congestion,  is  much 
relieved  by  cold  "  spinal  washings,"  or  gentle  douching  each  day  for  a  short 
time,  and  followed  by  good  friction.  Dr.  Moxon  has  recently  drawn  atten- 
tion to  the  comparatively  feeble  circulation  in  the  lower  part  of  the  cord, 
and  doubtless  such  remedies  act  by  quickening  and  regulating  the  blood- 
current  in  that  part  (Croonian  Lectures,  British  Medical  Journal,  i.,  1881 ). 

The  more  acute  backache,  commonly  felt  by  women,  and  in  the  absence 
of  definite  cause  traceable  often  to  "  anaemia  of  the  cord  "  (Bartholow),  is 
better  relieved  by  hot  applications;  and  if  the  douche  be  not  obtainable, 
then  a  hot  sponge  or  fomentation  will  serve. 

THERAPEUTICAL  ACTION  (INTERNAL). —  Preissnitz  and  his  early  fol- 
lowers combined  with  the  outward  application  of  cold  water  its  immoder- 
ate and  excessive  use  internally,  an  error  which  led  to  some  evil  result, 
and  which  is  not  often  now  repeated.  Water-drinking  is  now  ordered  on 
general  dietetic  principles  rather  than  as  an  essential  part  of  a  hydro- 
pathic course  (Braun,  chap.  v.).  In  chronic  illness  good  results  are  more 
rapidly  and  easily  obtained  by  the  use  of  mineral  waters  in  moderate 
quantities,  and  containing  salts  and  gas,  so  that  the  number  of  illnesses 
in  which  ordinary  water  is  internally  employed  as  a  remedy  is  not  large. 
Its  most  common  internal  use,  medicinally,  is  as  a  solvent  and  diluent. 

In  Fevers  of  all  kinds  it  is  used  to  lessen  thirst,  to  lower  temperature, 
and  restore  the  balance  of  fluid  constituents  of  the  tissues;  also  to  promote 
secretion  and  the  elimination  of  waste  products. 

Nephritis. — A  copious  supply  of  pure  water  is  an  effective,  non-irritant 
diuretic,  and  is  very  useful  in  acute  renal  congestion  and  inflammation, 
washing  out  epithelium  and  ca^ts  from  the  obstructed  tubules.  It  renders 
more  soluble,  also,  and  helps  to  carry  off,  all  the  products  retrograde  met- 
amorphosis, and  the  good  effect  of  many  infusions  and  decoctions  is  doubt- 
less largely  due  to  the  amount  of  water  they  contain. 

Constipation.  —  A  glass  of  cold  water  taken,  fasting,  in  the  early 
morning,  will  assist  in  securing  a  regular  action  of  the  bowels.  If  taken, 
also,  the  last  thing  at  night,  it  has  a  still  better  effect.  Cold  hip-baths 
are  useful  for  the  same  purpose. 

JTcemorrhoids. — Plentiful  water-drinking  is  indicated  in  this  disorder 
as  a  means  of  relieving  the  liver  by  securing  a  greater  flow  of  bile  and 
accelerating  elimination,  but  a  course  of  aperient  mineral  waters  is  more 
effective. 

Chronic  Metallic  Poisoning. — In  some  cases  of  this  kind,  the  taking 
of  a  large  quantity  of  water  is  useful  by  aiding  solution  of  minerals  de- 
posited in  the  tissues,  e.g.,  antimony,  arsenic,  lead,  copper,  mercury,  etc., 
or  rather  their  mechanical  removal  by  disintegration  of  cells.  If,  how- 
ever, anaemia  be  marked,  as  it  often  is,  this  method  must  be  used  with  care, 
for  fear  of  impairing  nutrition. 

Syphilis. — In  the  later  stages  of  syphilis,  or  when  relapses  are  fre- 


150  MATERIA    MEDICA    AND    THERAPEUTICS. 

quent,  and  mercury  or  iodides  are  not  well  borne,  hydropathic  treatment 
is  a  useful  resource,  tissue-change  being  promoted  by  the  wet  sheet  and 
free  water-drinking.  Good  results  are  also  derived  in  this  disease  from 
the  eliminant  influence  of  the  Turkish-bath,  and  the  occasional  use  of  this 
during  a  mercurial  course  is  always  advisable. 

Gout — Gravel. — In  these  cases,  hydrotherapy  can  improve  the  gen- 
eral condition,  and  sometimes,  it  is  said,  disperse  concretions.  It  pro- 
motes lixiviation  and  increased  change  of  substance,  as  shown  by  increase 
of  urea,  and  renders  uric  acid  soluble.  It  will  not,  however,  produce  the 
marvellous  cures  sometimes  expected  of  it. 

The  dietetic  use  of  hot  water  in  gout  has  been  recommended,  one  or 
two  tumblerfuls  of  water  at  120°  being  given  in  the  early  morning.  This 
is  said  to  regulate  the  bowels,  to  cause  the  disappearance  of  lithic  acid 
and  lithate  sediments,  and  diminish  the  frequency  of  acute  attacks  (Web- 
er). Cadet  de  Vaux  (1825)  carried  this  idea  to  an  extravagant  pitch, 
ordering  8  oz.  of  hot  water  (120°  to  140°  F.)  every  quarter-hour  for  twelve 
hours.  Some  patients  bore-this,  but  others  suffered  from  vomiting,  ex- 
citement, congestion  of  the  brain,  or  fever. 

The  formation  of  gravel  is  caused,  according  to  Scherer,  not  by  ex- 
cessive secretion  of  acid,  but  by  the  fermentation  of  the  urine  itself,  yet 
the  diminution  of  the  secretion  of  acid  must  produce  a  favorable  effect; 
and  also  the  dilution  of  the  urine  renders  it  less  irritating  to  the  mucous 
membrane,  and  washes  away  from  the  membrane,  mucus  which  would 
produce  fermentation.  Hence  plain  water-drinking  is  good  in  this  condi- 
tion (Braun),  though  preference  is  now  commonly  given  to  mineral  waters. 


SEA-BATHING. 

In  sea-water  the  more  important  saline  constituents  are  the  chlorides 
of  sodium  and  magnesium,  and  the  sulphate  and  carbonate  of  lime.  Io- 
dides and  bromides  are  contained  in  minute  quantity.  Hence  the  effect 
of  sea-bathing  upon  the  skin  and  its  peripheral  nerves  is  more  stimulating 
than  that  of  ordinary  water,  an  effect  which  is  much  heightened  by  the 
stroke  of  the  waves  (Wellenschlag). 

The  incoming  wave  beats  more  upon  the  upper  part  of  the  person,  the 
receding  wave  upon  the  lower  extremities,  providing  one  of  the  best  forms 
of  douche-bath  for  such  as  are  strong  enough  to  bear  it. 

This  wave-stroke  is  naturally  more  effective  in  some  seas  and  on  some 
coasts  than  on  others.  In  the  German  Ocean  (east  coast  of  England) 
and  in  the  Atlantic  (south  coast)  it  is  much  stronger  than  in  the  Baltic 
or  the  Mediterranean,  and  bathing  at  Cannes,  for  instance,  is  not  to  be 
compared  in  bracing  effect  with  bathing  at  Brighton. 


SEA-BATHING.  151 

The  temperature  of  the  water  is  an  important  point  in  estimating  the 
effect  of  any  form  of  bath.  The  temperature  of  the  sea  varies  less  through- 
out the  year  than  that  of  rivers:  it  is  highest  in  the  Mediterranean  (72° 
to  80°  F.),  lowest  in  the  Baltic  (60°  to  62°  F.),  and  intermediate  in  the 
Atlantic  (68°  to  73°  F.).  It  is  higher  in  autumn  than  in  summer,  and 
hence,  September  is  a  good  month  for  sea-bathing,  though  the  wave- 
stroke  is  not  then  so  forcible  as  it  is  earlier.  The  temperature  of  the 
water  is  often  as  much  as  12°  F.  higher  than  that  of  the  air,  and  at  mid- 
day it  is  several  degrees  higher  than  in  the  early  morning. 

In  considering  the  influence  of  sea-water,  that  of  sea-air  must  not  be 
wholly  omitted.  It  contains  more  ozone,  more  moisture,  and  more  salt 
than  country  air,  with  less  carbonic  acid,  and  usually  less  dust  and  for- 
eign admixture;  in  fine  weather  the  air  is  more  clear  and  the  sun-light 
more  powerful  at  the  coast  than  inland,  and  the  current  of  the  air  is  usual- 
ly stronger  and  more  bracing. 

PHYSIOLOGICAL  ACTION. — On  entering  the  water,  under  ordinary  con- 
ditions, a  sense  of  cold  is  felt;  the  skin  becomes  pale  and  roughened 
(goose-flesh),  the  circulation  depressed,  and  the  respiration  more  or  less 
spasmodic;  but  in  suitable  subjects  this  temporary  depression  is  quickly 
followed  by  reaction — the  skin  reddens,  the  pulse  rises  and  becomes  more 
forcible,  while  exhilaration  and  a  sense  of  increased  vigor  indicate  the 
stimulation  of  the  nervous  system.  If  the  bather  avoid  overtaxing  his 
powers,  and  will  leave  the  bath  before  this  period  of  stimulation  is  passed, 
he  will  probably  retain,  for  several  hours,  a  feeling  of  improved  health 
and  general  well-being,  and  it  is  to  such  cases  that  the  following  state- 
ment of  physiological  results  will  apply. 

Tissue-change  is  promoted,  as  shown  by  an  increased  excretion  of  urea 
and  sulphuric  acid  (Beneke);  not  that  these  are  immediately  or  inordin- 
ately increased,  but  the  natural  healthy  maximum  is  kept  up  for  a  much 
longer  time  than  usual  (Ringer).  Appetite  and  digestion  are  certainly 
promoted;  but  if  only  such  a  measured  amount  of  food  be  taken  as  suf- 
fices to  maintain  the  body-weight  at  a  fixed  point  under  ordinary  circum- 
stances, loss  of  weight  is  experienced  owing  to  the  increased  tissue-change, 
while  if  the  quantity  of  food  be  increased  in  proportion  to  the  improved 
appetite  and  digestion,  the  body- weight  is  decidedly  increased  by  a  course 
of  sea-bathing.  • 

The  skin-secretion,  though  at  first  checked,  is  afterward  promoted: 
the  effect  of  the  first  contraction  of  the  skin  capillaries  is  sometimes,  if 
the  water  be  very  cold,  to  determine  blood  to  internal  organs,  and  hence 
some  congestion  of  the  kidneys  may  occur,  and  a  trace  of  albumen  may 
be  found  in  the  urine;  but  this  condition  soon  passes  off,  and  the  albu- 
men does  not  persist  after  the  bath. 

The  urinary  water  is  increased  at  the  time,  though  it  is  said  that  the 
day's  total  is  rather  less  than  normal.  The  intestinal  excretion  is  usually 


152  MATERIA   MEDICA   AND   THERAPEUTICS. 

lessened,  but  sometimes  increased  (Beneke),  and  either  constipation  or 
diarrhoaa  may  be  induced. 

Restlessness  and  sleeplessness  are  more  serious  symptoms  occasionally 
caused,  but  in  my  experience  as  much  by  a  residence  on  the  sea-level  as 
by  simple  bathing.  The  hot,  strongly  saline  baths,  as  at  Droitwich,  do, 
however,  often  induce  an  extreme  degree  of  restlessness,  and  should  not 
be  used  too  frequently. 

It  is  worth  noting  that  the  long  hair  of  women,  when  often  soaked 
with  salt-water,  may  fall  off,  but  it  quickly  grows  again. 

THERAPEUTICAL  ACTION. — Sea-bathing  tends  to  "  harden  the  skin," 
to  moderate  undue  perspiration,  and  to  diminish  the  tendency  to  catching 
cold  and  to  rheumatic  attacks.  It  acts  as  a  general  stimulant  in  all  con- 
ditions of  constitutional  debility,  and  also  as  a  local  stimulant,  promoting 
absorption  and  improving  circulation. 

In  Chronic  Forms  of  Nerve- Disorder  with  depression,  and  hypochon- 
driasis,  sea-bathing  is  often  very  beneficial  through  a  strongly  stimulant 
action  on  the  peripheral  cutaneous  nerves:  by  its  influence  on  tissue- 
change  it  is  said  to  benefit,  not  only  in  functional  disorder,  but  even  after 
material  change  in  the  nerve-substance  (Husemann). 

Struma,  etc. — In  various  forms  of  struma,  scrofula,  and  chronic  condi- 
tions of  blood-poisoning,  sea-baths  are  indicated,  and  during  convalescence 
from  fevers  and  other  acute  disorders,  or  after  prolonged  town-residence 
or  town-work,  they  have  an  excellent  effect. 

Sprains,  etc. — As  a  remedy  for  the  effects  of  sprain  or  of  injury  to 
joints,  or  of  spinal  weakness,  douches  of  hot  and  cold  sea-water  are  ex- 
ceedingly useful. 

Recently  gargles  of  the  same  are  said  to  have  proved  curative  in 
chronic  relaxed  conditions  of  throat,  "  Clergyman's  Sore  Throat,"  etc. 
(British  Medical  Journal,  July,  1879). 

TIME  OP  BATHING. — To  bathe  before  breakfast  is  the  custom  of  some 
robust  persons,  but  is  never  free  from  risk,  and  sometimes  seriously  in- 
jures weakly  subjects:  for  after  the  long  fast  of  night  the  circulatory  and 
central  nervous  organs  are  more  liable  to  depression  from  sudden  shock 
or  over-fatigue.  On  the  other  hand,  to  bathe  soon  after  a  meal  arrests 
the  process  of  digestion,  and  may  give  rise  to  very  unpleasant  gastric  and 
cerebral  symptoms.  The  best  results  are  obtained  from  bathing  two  or 
three  hours  after  the  early  morning  meal,  when  the  stomach  is  nearly 
empty,  and  there  should  be  at  least  a  brief  interval  of  rest  or  of  but  mod- 
erate exercise,  according  to  the  weather,  between  the  bath  and  the  fol- 
lowing meal.  The  object  aimed  at  being  a  marked  and  prolonged  reac- 
tion, this  is  best  obtained  from  a  bath  taken  during  a  condition  of  the 
greatest  nutritive  and  functional  activity,  when  the  work  of  the  stomach 
is  over  and  the  blood  is  enriched  by  the  products  of  digestion. 

ERRORS  IN  BATHING. — The  good  effects  already  described  as  proper 


MINERAL    WATERS    AND    BATHS.  153 

to  sea-bathing  may  be  missed,  and  very  unpleasant  symptoms  may  arise, 
if  attention  be  not  given  to  certain  points. 

The  therapeutical  object  is  to  secure  and  sustain  a  good  reaction,  and 
this  is  impaired  if  the  bath  be  too  cold,  or  too  prolonged,  or  if  excessive 
exertion  be  taken  before,  during,  or  after  it,  or  if  the  patient  be  under 
the  influence  of  strong  emotion,  as  a  nervous,  frightened  child  would  be. 
The  most  common  errors  are  to  prolong  the  bath  unduly  and  to  exert 
one's  self  overmuch  during  it:  the  sense  of  vigor  is  then  replaced  by  ex- 
haustion, the  skin  again  becomes  cold,  and  the  circulation  depressed; 
giddiness  and  headache  occur  from  altered  conditions  of  the  circulation, 
with  general  malaise,  and  possibly  shivering,  nausea,  sickness,  and  a  sense 
of  depression  lasting  for  many  hours.  It  is  therefore  important  to  leave 
the  bath  before  the  stage  of  reaction  and  stimulation  is  finished.  With 
some  persons  the  stroke  of  three  or  four  good  waves  is  sufficient  for  the 
best  results,  five  minutes  is  an  average  time  for  the  delicate  to  remain  in 
the  water,  and  no  one  bathing  for  health  only  should  remain  in  the  open 
sea  for  more  than  ten  minutes. 

CONTRA-INDICATIONS. — At  the  extremes  of  life,  sea-bathing  in  the 
open  should  be  practise'd  cautiously.  As  a  rule,  it  is  unsuited  for  children 
under  two  years  of  age,  or  for  patients  over  sixty.  Pregnancy  in  healthy 
subjects  need  not  prevent  the  use  of  salt-baths,  or  sea-bathing,  provided 
that  the  patient  is  accustomed  to  a  cold-bath  previously,  but  as  a  rule, 
the  various  inconveniences  of  open-air  bathing  render  its  risks  greater 
than  any  advantage  in  that  state.  The  tendency  to  cause  congestion, 
more  or  less  temporary,  of  internal  organs,  the  brain,  liver,  lung,  or  kid- 
ney, renders  open-air  sea-bathing  unsuitable  for  persons  disposed  to  such 
disorders,  or  suffering  from  structural  change  or  marked  blood-stasis 
within  the  abdominal  organs,  albuminuria,  serious  cardiac  disease,  chronic 
pneumonic  infiltrations,  haemoptysis,  fatty  degeneration,  or  rheumatism 
which  is  at  all  acute.  An  extreme  degree  of  anaemia  is  a  contra-indica- 
tion. 


MINERAL  WATERS  AND  BATHS. 

The  so-called  mineral  waters  are  really  medicines,  largely  diluted  and 
complex,  containing  various  salts  and  gases  derived  from  the  soils  through 
which  they  pass,  and  administered  at  varying  temperatures,  generally 
warm. 

PHYSIOLOGICAL  ACTION. — Applied  externally  in  the  various  forms  of 
bath,  they  act  like  the  plain  water-baths  already  described,  with  special 
powers  of  stimulating  the  skin,  and  indirectly  the  visceral  circulation,  or 
of  quickening  absorption  and  lessening  pain. 

Given  internally,  they  act  by  promoting  tissue-change,  secretion,  and 


154  MATEEIA   MEDICA    AND    THERAPEUTICS. 

excretion,  thus  diluting  and  depurating  the  blood,  and  increasing  the  bile 
and  other  organic  liquids.  "  Critical  eruptions  and  discharges  may  occur 
during  their  administration,  but  are  not  advantageous." 

Their  action  is  not  to  be  explained  solely  by  the  proportion  of  .ingre- 
dients recognized  by  an  analysis — e.g.,  !•£•  dr.  of  magnesia  sulphate  has 
far  more  purgative  effect  when  taken  in  the  form  of  a  natural  water  than 
when  dispensed  by  a  chemist,  and  hence,  although  imitated,  they  cannot 
be  quite  replaced  by  artificial  combinations. 

THERAPEUTICAL  ACTION. — Mineral  waters  are  mainly  used  in  chronic 
functional  disorders,  and  in  conditions  of  debility  and  convalescence,  but 
are  suitable  also  for  early  stages  of  organic  disease.  In  estimating  their 
effects,  allowance  must  be  made  for  the  change  of  climate  and  surround- 
ings, and  the  more  regular,  simple,  and  quiet  life  of  a  Spa.  Hence  the 
drinking  of  imported  waters  at  home  will  not  give  the  same  result  as 
taking  them  at  their  source. 

Season. — The  usual  season  for  drinking  the  mineral  waters  includes 
summer  and  autumn,  i.e.,  extends  from  May  or  June  to  September  or 
October,  and  the  duration  of  a  course  is  from  three  to  six  weeks.  Too 
prolonged  continuance  of  the  treatment  is  liable  to  do  harm. 

DOSE  AND  MODE  OF  ADMINISTRATION. — It  must  be  recognized  that 
benefit  is  not  derived  in  proportion  to  the  quantity  of  water  taken:  at 
first  only  small  quantities  daily  are  desirable.  Bathing  and  drinking 
should  not  be  commenced  on  the  same  day.  When  the  strength  permits, 
early  rising  is  advisable,  so  that  the  water  may  be  taken  before  breakfast; 
it  should  be  sipped  slowly,  and  an  interval  allowed  for  a  gentle  walk  be- 
tween each  glass.  The  diet  should  be  carefully  regulated — it  is  usually 
less  generous  abroad  than  in  this  country.  As  a  rule,  some  physician 
resident  at  the  Spa  should  be  consulted. 


CLASSIFICATION. 

Braun,  in  his  excellent  treatise  (edited  by  Dr.  H.  Weber,  1875), 
classifies  "Mineral  Waters"  somewhat  as  follows: — 

CLASS  1 — CARBONIC  ACID  WATERS  comprise  many  of  various  char- 
acter, more  or  less  impregnated  with  this  gas,  which  renders  them  easier 
of  digestion,  and  chemically  assists  the  solution  of  bicarbonates,  e.g.,  of 
soda  and  iron.  Their  medicinal  properties  are,  to  lessen  gastric  irrit- 
ability, to  stimulate  slightly  the  secretions  of  the  stomach  and  of  the  kid- 
neys, and  to  increase  the  peristaltic  action  of  the  intestines. 

There  are  a  few  springs  which  contain  only  a  small  amount  of  saline 
ingredient  with  so  much  gas  that  they  may  be  called  simple  acidulated 
or  carbonated  waters,  but  none  of  these  are  active  enough  to  be  in  demand 
beyond  their  own  locality.  All  the  commonly  used  aerated  waters  con- 


MINERAL    WATERS   AND   BATHS.  155 

tain  a  notable  proportion  of  alkalies,  chlorides,  earths,  or  iron,  and  hence, 
although  containing  carbonic  acid,  find  their  place  rather  in  the  following 
classes. 

CLASS  2 — SALINE  WATERS. 

(a)  Simple  Alkaline  Waters  (containing  carbonate  of  soda  as  a  main 
ingredient),  are  such  as  those  of  Vichy  and  Neuenahr,  Salzbrunn,  Mont 
Dore,  Bilin,  Gieshiibel,  Apollinaris,  etc. 

(b)  Muriatic  Soda  Waters  contain  in  addition  sufficient  chloride  of 
sodium  to  correct  the  dyspepsia  or  debility  sometimes  induced  by  a.  pure 
soda  water,  and  are  those  of  Luhatschowitz,  Ems,  La  Bourboule,  etc. 
(v..pp.  158,  159). 

These  and  the  preceding  waters  are  ordered  in  cases  of  acid  gravel, 
gout,  venous  stasis,  and  abdominal  obstruction,  in  scrofulous  exudations, 
in  diabetes,  and  in  chronic  catarrh  of  the  respiratory,  gastric,  or  genito- 
urinary tract.  In  catarrh  especially,  waters  containing  chloride  are  to  be 
preferred. 

(c)  Sitter  Waters  ("purging  saline  waters")  containing  sulphate  of 
soda  and  magnesia  as  chief  ingredients  are  such  as  Friedrichshall,  Hunyadi 
Janos,  Piillna,  Seidlitz,  Epsom,  Beulah  Spa,  Purton,  Cheltenham,  Leam- 
ington, Scarborough  (v.  pp.  159-161). 

One  or  two  wineglassfuls  of  these  waters  (preferably  taken  warm) 
stimulate  the  gastro-intestinal  mucous  membrane,  and  produce  a  watery 
discharge  from  its  glands.  They  are  useful  in  habitual  constipation, 
especially  when  this  is  connected  with  torpor  or  congestion  of  the  liver; 
but  if  given  too  frequently,  or  in  excessive  dose,  they  are  apt  to  bring  on 
flatulence,  dyspepsia,  or  intestinal  catarrh  in  delicate  subjects. 

(d)  Compound  Soda  Waters  (containing  sulphate  of  soda  in  effective 
doses)  are  Carlsbad,  Marienbad,  Franzensbad,  Tarasp,  etc.  (v.  pp.  161- 
163).     These  are  ordered  in  gout,  gravel,  diabetes,  and  catarrh,  like  the 
simple  soda  waters,  and  also  more  especially  in  dyspepsia,  corpulence, 
jaundice,  gall-stones,  and  hyperaemic  enlargement  of  the  liver,  and  in 
haemorrhoids  occurring  in  plethoric  persons.    These  waters,  if  freely  used, 
are  markedly  lowering  in  their  action. 

(c)  Common-Salt  Waters  include  those  of  Homburg,  Kissengen, 
Baden-Baden,  Wiesbaden,  Reichenhall,  Kreuznach,  Harrogate  (v.  pp. 
163,  168). 

These  waters  are  used,  taken  cold  and  in  but  moderate  quantity,  in 
dyspepsia  and  gastric  catarrh;  also  in  constipation  and  chronic  intestinal 
catarrh;  for  early  stages  of  abdominal  plethora,  and  for  haemorrhoids  and 
venous  stasis  occurring  in  thin  depressed  subjects;  also  in  bone  disease 
and  scrofulous  exudations,  inflammatory  effusions,  and  glandular  and 
even  fibroid  tumors. 

CLASS  3 — SULPHUR  WATERS,  which  contain  alkaline  sulphides  or  sul- 
phuretted hydrogen,  are  found  at  Aix-la-Chapelle  and  Aix-les-Bains, 


156  MATERIA    MEDICA    AND    THERAPEUTICS. 

Weilbach,  Bareges,  Luchon,  Cauterets,  Harrogate,  Llandrindrod,  Moffat, 
Lisdoonvarna,  etc.  (v.  pp.  168-172).  They  are  used  for  chronic  syphilitic 
and  scrofulous  disorders,  bronchial  catarrh  and  phthisis,  chronic  hepatic 
congestion,  chronic  rheumatism,  and  metallic  poisoning,  such  as  that 
from  lead  or  mercury.  The  digestive  powers  are  liable  to  be  taxed  by  a 
course  of  these  waters,  and  more  or  less  anaemia  is  apt  to  follow.  Good 
meat  diet  is  desirable  while  sulphur  is  being  taken. 

CLASS  4 — EARTHY  MINERAL  WATERS  (containing  a  large  proportion 
of  lime). — Rehme,  Eilsen,  Leuk,  Weissenburg,  Wildungen,  etc.,  and 
many  other  waters,  contain  a  small  proportion  of  carbonates  of  lime  and 
of  magnesia  (v.  pp.  172-174).  The  special  springs  named  are  used  in  vesi- 
cal  catarrh  and  uric  acid  concretions,  in  gouty  and  scrofulous  exudations 
and  skin  diseases,  also  in  bronchial  catarrh  and  phthisis.  Separate  classes 
are  made  by  some  authors,  e.g.,  of  the  iodo-bromated  waters  at  Kreuznach 
and  Woodhall,  and  the  muriated  lithia  waters  of  Baden-Baden. 

CLASS  5 — THE  "  INDIFFERENT  "  WATERS  of  Leuk,  Gastein,  Wildbad, 
Schlangenbad,  Buxton,  etc.,  are  used  almost  wholly  in  the  form  of  bath  in 
cases  of  rheumatism,  paralysis,  and  other  nervous  disorders  (v.  pp.  ]  74— 
176). 

CLASS  6 — CHALYBEATE  WATERS,  those  in  which  iron  carbonate  is  the 
main  ingredient,  are  such  as  Spa,  Schwalbach,  Tunbridge  Wells,  Dri- 
burg,  Pyrmont,  Harrogate.  The  sulphate  occurs  in  springs  at  Brighton 
and  at  Sand  Rock  (Isle  of  Wight);  the  perchloride  in  a  spring  at  Harro- 
gate (Muspratt's). 

These  waters  are  used  in  chlorosis,  direct  anaemia,  irregularities  of 
menstruation,  atonic  conditions  of  the  stomach  and  intestine,  in  general 
debility,  and  in  various  neuroses.  Care  is  required  to  secure  their  due 
absorption  without  dyspepsia.  The  general  rules  for  iron-medication  are 
further  indicated  in  the  chapter  on  that  remedy. 

A  knowledge  of  Spas  and  mineral  waters  is  so  necessary  in  modern 
practice  that  a  more  detailed,  though  necessarily  brief,  account  of  the 
principal  ones  is  subjoined. 


CLASS  2  (a).— SIMPLE  ALKALINE  WATERS. 

Vtchy,  in  central  France,  seven  hundred  and  eighty  feet  above  the 
sea,  is  situated  on  the  River  Allier,  in  a  large  open  valley  surrounded  by 
vine-clad  hills;  the  climate  is  mild,  the  season  is  from  the  middle  of  May 
to  mid-September.  The  arrangements  are  on  a  magnificent  scale,  and 
the  Spa  is  the  most  frequented  in  Europe  (Braun). 

The  springs  used  are  nine  in  number,  all  clear,  warm,  and  tasting 
more  or  less  like  soda  water;  they  contain  from  36  to  39  gr.  of  bicarbo- 


MINERAL    WATERS   AND    BATHS.  157 

nate  of  soda  in  each  pound  (16  oz.),  from  12  to  14  cub.  in.  of  carbonic 
acid,  and  small  quantities  of  chloride  of  sodium  (4  gr.),  of  bicarbonate  of 
potash,  and  of  magnesia,  and  arseniate  of  soda. 

They  may  be  used  in  any  case  in  which  strong  alkaline  waters  are  in- 
dicated, and  either  for  bathing  or  drinking,  or  both.  The  Grande  Grille, 
which  has  a  temperature  of  113°  F.  is  in  most  repute,  especially  for  hepa- 
tic disorders,  the  Celestins  for  urinary  maladies,  and  the  Hopital  for  ab- 
dominal stasis,  chronic  enteritis,  etc.  The  JIauterive  is  cold,  and  con- 
tains an  unusually  large  amount  of  carbonic  acid. 

The  most  suitable  cases  for  Vichy  are  those  of  uric  acid  gravel  and 
calculus,  gout,  vesical  catarrh,  and  diabetes  of  the  slow  and  less  pro- 
nounced kind.  But  besides  these,  a  large  number  of  other  maladies  are 
treated  there  with  more  or  less  success — such  as  dyspepsia,  gastric 
catarrh,  enlargement  of  liver  and  spleen,  abdominal  congestions,  chronic 
metritis,  and  chronic  rheumatism.  The  dose  of  the  water  is  from  half  a 
pint  to  two  pints  daily. 

Vals,  in  the  southeast  of  France  (Department  Ardeche),  is  an  im- 
portant Spa  with  cold  alkaline  springs,  similar  in  composition  to  the 
waters  of  Vichy.  The  principal  ones,  jPrecieuse,  Desiree,  Madeleine,  and 
JRigolette,  contain  rather  more  bicarbonate  of  soda  and  carbonic  acid  and 
iron.  The  two  former,  slightly  laxative,  are  employed  in  gouty  and  re- 
nal disorders;  the  two  latter  are  more  roborant.  St.  Jean  is  less  alka- 
line, and  is  ordered  for  dyspepsia;  Dominique  is  arsenical.  The  waters 
of  Vals  and  Vichy  are  largely  exported. 

JVeuenahr,  in  Rhenish  Prussia,  three  hundred  feet  above  the  sea,  in 
the  mild  and  beautifully  wooded  valley  of  the  Ahr,  is  easily  reached  from 
Cologne.  It  has  excellent  buildings  and  public  gardens,  and  js  rising  in 
estimation.  It  possesses  a  cold  spring  rich  in  carbonic  acid,  and  four 
warm  springs — 93°  to  104°  F. — each  containing  about  9  gr.  in  the  pound 
of  bicarbonate  of  soda,  with  a  small  proportion  of  lime  and  magnesia, 
much  carbonic  acid,  very  little  chloride  of  sodium  or  iron. 

JBilin,  in  Bohemia,  and  Fachingen,  in  the  valley  of  the  Lahn,  contain 
strong  soda  springs,  which,  however,  are  but  little  used  on  the  spot, 
though  they  are  exported  in  large  quantities.  The  water  of  Bilin  con- 
tains 33  gr.  of  bicarbonate  in  the  pound,  with  chloride  2  gr.,  and  sulphate 
6  gr.,  lime  4  gr.,  a  trace  of  iron,  and  much  carbonic  acid,  at  a  temperature 
of  53°  F.,  and  generally  requires  to  be  heated.  That  of  Fachingen  is 
very  similar,  but  somewhat  weaker.  Both  are  used  for  severe  cases  of 
gravel,  gout,  and  vesical  catarrh. 

The  water  of  Gieshubel,  near  Carlsbad,  contains  a  small  proportion 
(10  gr.  to  the  pound)  of  bicarbonate  of  soda,  with  a  large  amount  (55 
cub.  in.  to  the  pound)  of  carbonic  acid.  It  is  pleasant  and  refreshing, 
and  exerts  a  moderate  antacid  effect. 

Apollinaris  water,  from  a  spring  of  that  name,  situated  near  Neu- 


158  MATERIA    MEDIC  A    AND    THERAPEUTICS. 

enahr,  in  the  valley  of  the  Ahr,  contains  about  10  gr.  of  bicarbonate  of 
soda,  3  gr.  of  chloride,  2  gr.  of  sulphate,  and  3  gr.  of  magnesian  carbon- 
ate, with  a  large  amount  of  carbonic  acid  to  the  pound,  so  that  it  may 
be  warmed  without  losing  its  pungency. 

It  is  useful  as  a  table  water  in  irritable  conditions  of  the  stomach, 
and  as  a  medicinal  water  in  the  lithic  acid  diathesis  and  gout;  also  in 
bronchial  catarrh  and  tendency  to  gall-stone. 

Salzbrunn,  in  Silesia,  near  Freiburg,  situated  in  a  wooded  valley 
twelve  hundred  feet  above  the  sea,  has  a  fresh  bracing  climate,  and  has 
soda  waters  with  about  18  gr.  of  bicarbonate  in  the  pound  (16  oz.).  It 
has  been  called  "  the  cold  Ems,"  and  has  been  especially  recommended 
in  bronchial  catarrh  and  in  early  stages  of  consumption  when  Ems  is  not 
suitable.  A  much  frequented  establishment  for  the  "  whey-cure "  and 
"  moor-baths  "  is  also  to  be  found  at  Salzbrunn. 

Mont  Dore  lies  in  a  charming  valley  of  the  Auvergne  Mountains, 
thirty-three  hundred  feet  above  the  sea,  and  possesses  a  cold  and  several 
warm  soda  springs  (106°  to  108°  F.).  They  contain  only  about  5  gr.  of 
bicarbonate  to  the  pound,  but  more  chloride  of  sodium  than  those  yet 
mentioned,  also  an  excess  of  carbonic  acid.  The  Madeleine  is  also  arseni- 
cal. The  Spa  is  well  provided  with  appliances  for  separate  baths,  douches, 
sprays,  and  inhalations,  and  has  a  reputation  in  chronic  pulmonary  ca- 
tarrh and  asthma,  and  in  chronic  hepatic  congestion  and  rheumatism. 
"Most  invalids  employ  warm  bathing,  the  effect  of  which  is  to  increase 
perspiration,  and  after  some  days  to  induce  a  '  bath  fever,'  with  lassitude, 
constipation,  etc.,  but  this  soon  passes  off."  It  has  a  reputation  for  bene- 
fiting and  often  curing  emaciated  broken-winded  horses  with  bad  coughs. 
It  has  been  recently  proposed  to  introduce  all  the  resources  of  Mont  Dore 
into  an  English  establishment  at  Bournemouth. 

CLASS  2  (b).— MURIATIC  SODA    WATERS. 

Ems,  near  Coblenz,  in  the  valley  of  the  Lahn,  two  hundred  and  ninety- 
one  feet  above  the  sea,  is  the  oldest  and  most  famous  soda  spring.  It  is 
conveniently  reached  from  England,  has  excellent  hotels,  and  English- 
speaking  physicians.  The  valley  is  narrow,  between  high  mountains, 
with  attractive  scenery,  and  possessing  a  mild  climate.  "There  are  few 
bathing  resorts  where  a  sick  person  may  find  in  intercourse  with  nature 
and  man,  and  in  the  enjoyment  of  a  brilliant  but  unpretending  Spa-life, 
such  rich  opportunity  both  for  coming  out  of  himself,  and  for  self-reflec- 
tion. Ems  is  the  pearl  of  Germany  "  (Braun).  Cases  of  phthisis,  how- 
ever, should  not  be  sent  there,  as  by  day  the  air  is  hot  and  still,  and  in  the 
early  autumn,  mists  at  night  and  morning  are  frequent.  The  best  months 
are  May  and  June,  September  and  October.  During  July  and  August, 
when  many  English  people  go,  the  climate  is  likely  to  be  found  oppres- 


MINERAL    WATERS    AND    BATHS.  159 

sive  and  relaxing.  The  mineral  springs  contain  a  medium  amount  of  bi- 
carbonate of  soda  (10  gr.),  and  of  carbonic  acid  (19  cub.  in.),  and  of  chlo- 
ride (7  gr.),  with  very  small  amounts  of  lime  and  magnesia.1  The  main 
difference  between  the  springs  is  in  temperature,  the  Kranchen  being  at 
84°  F.,  and  the  Ifessel  at  114°  F.  They  are  often  given  with  goats'  or 
asses'  milk,  and  are  used  for  chronic  bronchial  disorders  with  irritable 
cough  but  little  secretion;  in  the  dyspepsia  of  persons  disposed  to  phthi- 
sis; and  for  eczema  and  prurigo;  also  for  lithuria,  though  less  often  than 
those  of  Vichy. 

The  baths  at  Ems  are  much  used.  The  well-known  Biibenquelle  is  a 
warm  ascending  vaginal  douche,  which  has  a  reputation  in  inflammatory 
and  engorged  conditions  of 'the  uterus. 

Luhatschowitz  (in  Moravia)  is  situated  in  a  pleasant  valley  of  the 
Carpathian  Mountains,  sixteen  hundred  feet  above  the  sea.  The  springs, 
four  in  number,  are  cold,  and  contain  in  each  pound  from  30  to  60  gr.  of 
bicarbonate  of  soda,  20  to  30  gr.  of  chloride  of  sodium,  with  traces  of 
iodide  and  bromide  of  soda,  and  a  large  amount  of  carbonic  acid  (Braun). 
"  They  are  the  ideal  of  strong  carbonated  muriatic  soda  waters,"  and  are 
valuable  in  severe  catarrhal  conditions,  especially  in  chronic  gastric  ca- 
tarrh, and  in  abdominal  congestion  and  gouty  exudations.  In  cases  of 
hyperaemic  enlargement  of  the  liver,  they  even  come  into  competition  with 
Carlsbad  water,  and  in  cases  where  the  strong  soda  waters  of  Vichy, 
Biiin,  etc.,  have  failed  in  their  effect,  it  is  well  worth  while  to  try  a  water 
containing  more  chloride;  this  salt  increases  the  effect  of  the  carbonate. 
Whenever  tissue-change  is  to  be  increased,  and  at  the  same  time  tissue- 
growth  promoted,  and  the  gastro-intestinal  secretions  stimulated,  soda 
waters  containing  common  salt  are  to  be  preferred. 

La  Bourboule,  in  the  Auvergne  district,  two  thousand  six  hundred 
feet  above  the  sea,  has  several  springs  of  different  temperatures  and  pro- 
portions, but  all  containing  carbonate  and  chloride  of  sodium,  and  also 
appreciable  quantities  of  arsenic. 


'CLASS  2  (c).—  BITTER   WATERS. 

Tfie  Friedrichshall  water,  which  is  largely  imported  from  a  spring  in 
Saxe-Meiningen,  contains,  in  a  pound,  sulphate  of  soda  46  gr.,  sulphate 
of  magnesia  39  gr.,  chloride  of  sodium  61  gr.,  chloride  of  magnesium  30 
gr.,  and  sulphate  of  lime  and  potash,  with  a  small  amount  of  carbonic 
acid  (Liebig).  This  water  is  useful  in  small  non-aperient  doses  for  pro- 
moting tissue-change,  and  in  aperient  doses  is  frequently  prescribed  for 
habitual  constipation,  hepatic  congestion,  abdominal  plethora,  etc. 

1  In  this  and  all  the  following  analyses  the  quantities  are  calculated  for  a  pound  of 
water  (16  ounces). 


160 

The  Hunyadi  Janos  waters  are  the  richest  bitter  waters  yet  known. 
Sixteen  ounces  contain  138  gr.  of  sulphate  of  magnesia,  129  gr.  of  sul- 
phate of  soda,  with  11  gr.  of  chloride,  and  13  gr.  of  carbonate  of  soda. 
They  are  used  in  the  same  class  of  cases  as  those  last  mentioned,  but  are 
more  active  and  are  rather  less  unpleasant  to  the  taste. 

Pallna  water  is  of  the  same  character,  but  intermediate  in  strength 
between  Friedrichshall  and  Hunyadi  Janos,  containing  123  gr.  of  sulphate 
of  soda,  and  93  gr.  of  magnesia,  with  carbonate  of  the  same,  and  chloride 
of  sodium. 

Seidlitz  contains  no  sulphate  of  soda,  but  104  gr.  of  sulphate  of  mag- 
nesia. 

.The  once  famous  Epsom  well  contains  in  the  pound  240  gr.  of  sul- 
phate of  magnesia,  to  which  it  has  given  its  name. 

The  Beulah  Spa  (Norwood)  contains  61  gr.  of  Epsom  salt,  with  9  gr. 
of  soda  sulphate,  and  some  chloride. 

The  Streatham  and  Kilburn  Wells  resemble  the  Beulah  Spa. 

JPurton  Spa,  near  Swindon,  has  23  gr.  of  each  sulphate,  together  with 
chloride,  lime  sulphate,  and  some  carbonic  acid  (which  is  deficient  in  most 
waters  of  this  class);  also  traces  of  bromides,  iodides,  and  sulphuretted 
hydrogen.  This  water  is  used  as  an  "  alterative  stimulant "  in  strumous 
sores  and  enlarged  glands,  threatened  consumption,  hepatic  disorders, 
rheumatism,  chronic  skin-disorders,  and  uterine  derangements.  Half  a 
pint  to  a  pint  of  the  water  is  taken  before  breakfast,  and  another  half- 
pint  in  the  evening.  The  air  of  the  place  is  dry  and  bracing. 

Cheltenham  possesses  saline  springs  of  several  qualities.  That  of 
the  Royal  Old  Well,  first  noted  for  the  cure  of  George  the  Third,  con- 
tains chiefly  chlorides  of  calcium,  sodium,  and  magnesium,  with  sulphate 
of  soda  and  a  little  carbonic  acid. 

The  Pittville  Saline  contains  an  unusual  proportion  of  silica.  Spring 
No.  4,  Montpellier,  contains  a  large  amount  of  common  salt  (52  gr.  in  the 
pint),  with  17  gr.  sulphate  of  soda,  and  14  gr.  of  magnesia,  but  is  de- 
ficient in  carbonate  of  soda  and  carbonic  acid.  This  might  be  remedied, 
as  Dr.  Macpherson  suggests,  by  adding  a  certain  quantity  of  Bilin  or  of 
Vals  water,  and  the  temperature  might  be  graduated,  and  very  useful  re- 
sults again  obtained  from  these  waters.  The  Montpellier  baths  are  well 
arranged,  and  include  vapor  douches  and  medicated  vapor  baths. 

In  winter  the  mild  and  equable,  though  rather  moist  climate,  would 
even  give  an  advantage  over  more  distant  Spas.  By  the  Cotswold  Hills 
the  town  is  sheltered  from  north  and  east  winds.  The  season  is  from  mid- 
April  to  October. 

At  Leamington,  the  saline  spring  Old  Well,  contains  in  the  pound 
40  gr.  of  soda  sulphate,  40  gr.  of  sodium  chloride,  20  gr.  of  calcium  chlo- 
ride, 3  gr.  of  chloride  of  magnesium,  traces  of  bromine  and  iodine,  and  2 
cub.  in.  of  carbonic  acid1,  also  nitrogen  and  oxygen;  temperature,  48°  F. 


MINERAL    WATERS    AND    BATHS.  161 

These  waters  are  alterative,  and  are  slightly  aperient,  more  active  than 
those  of  Cheltenham,  and  hence  suitable  for  invalids  of  "torpid  habit." 
I  have  used  them  with  advantage  in  hepatic  derangement. 

The  town  is  clean  and  pleasant,  less  protected  by  hills  than  Chelten- 
ham, and  hence  the  air  is  rather  colder  and  more  bracing;  it  is  humid, 
but  not  raw. 

At  Scarborough,  the  South  Well  contains  28  gr.  of  sulphate  of  mag- 
nesia with  13  gr.  of  sulphate  and  6  gr.  of  carbonate  of  lime,  some  common 
salt,  and  a  trace  of  iron.  The  amount  of  lime  is  rather  too  large  for  cases 
requiring  purgative  waters. 

OLA88  2  (d).— COMPOUND  SODA  WATERS. 

Carlsbad,  in  Bohemia,  situated  on  the  banks  of  the  Topel,  in  a  narrow 
valley  twelve  hundred  feet  above  the  sea,  is  one  of  the  principal,  as  it  is 
the  oldest  of  German  Spas.  The  season  is  from  the  end  of  May  to  the 
end  of  September;  at  other  times  the  climate  is  "  rough,"  though  in  May 
it  is  often  not  more  than  fresh  and  bracing.  Among  the  advantages  of 
Carlsbad,  Braun  reckons  the  careful  diet,  and  among  the  disadvantages 
"  an  excessive  use  of  coffee."  The  valley  is  rich  in  warm  springs,  which 
differ  little  in  their  fixed  constituents  though  much  in  their  temperature 
and  gaseous  contents.  The  Sprudel,  which  forms  a  fountain  several  feet 
high,  giving  off  clouds  of  vapor,  has  a  temperature  of  164°  F.,  contains 
11.8  cub.  in.  carbonic  acid,  and  sulphate  of  soda  18  gr.,  chloride  7  gr., 
carbonate  10  gr.,  with  a  little  lime,  magnesia,  and  iron.  The  /Schloss- 
brunnen  at  124°  F.  contains  17  cub.  in.  carbonic  acid.  The  Markbrun- 
nen  at  130°  F.  contains  in  addition  some  iodide  and  bromide  of  sodium. 

Carlsbad  waters  are  efficacious  in  several  forms  of  dyspepsia,  e.g., 
when  gastralgia  and  flatulence  occur  principally  after  meals,  and  when 
catarrhal  conditions  of  the  stomach  or  intestine  are  present,  and  morning 
vomiting,  or  diarrho3a  alternating  with  constipation.  For  corpulence, 
with  its  various  troubles,  they  are  a  tolerably  sure  and  gentle  remedy,  in- 
dependently of  violent  evacuations.  In  jaundice,  and  a  tendency  to 
gall-stones  and  allied  conditions,  the  waters  diminish  the  inflammation  and 
tumefaction  in  the  gall-ducts,  and  thus  enable  calculi  to  pass  more  easily. 
In  hepatic  and  splenic  enlargement  following  malarial  fevers,  especially 
if  constipation  be  marked,  and  in  passive  hyperasmia  of  the  portal  system 
and  abdominal  viscera  occurring  in  stout  florid  persons  with  a  tenden- 
cy to  haemorrhoids,  and  generally  sluggish  venous  circulation,  Carlsbad 
waters  are  very  effective.  "  Old  Indians  with  enlarged  livers  often  derive 
remarkable  benefit."  The  hypochondriasis  dependent  more  or  less  on  the 
above-named  conditions  is  also  relieved.  In  gout  and  gouty  conditions 
without  much  joint-affection,  especially  in  patients  with  abdominal  ple- 
thora and  commencing  atheromatous  change  in  the  vessels,  in  rheumatoid 
VOL.  L— 11 


162  MATERIA   MEDICA    AND   THERAPEUTICS. 

arthritis,  sciatica,  and  in  the  tendency  to  uric  acid  concretions  and  con- 
sequent catarrhal  affections  of  the  urinary  organs,  Carlsbad  waters  are 
often  quite  as  useful  as  the  stronger  alkaline  waters.  In  cases  of  the 
slower  and  milder  form  of  diabetes,  the  use  of  Carlsbad  waters  has  rapidly 
and  considerably  diminished  the  excretion  of  sugar,  and  after  some 
months  has  effected  great  improvement  in  the  general  condition  in  many 
instances.  Even  in  serious  cases,  provided  they  are  not  very  acute  and 
rapid  in  their  onset,  and  not  accompanied  by  phthisis,  the  same  waters 
have  often  effected  an  improvement,  and  checked  the  progress  of  the 
disease. 

In  these  observations  I  find  myself  in  agreement  with  Seegen  and 
Braun,  and  have  only  to  add  that  the  course  at  Carlsbad  need  not,  and 
should  not,  be  so  conducted  as  to  "  purge,  lower,  and  starve  "  the  patient. 
We  sometimes  hear  complaints  of  the  depression  and  debility  induced, 
and  certainly,  an  excessive  use  of  the  waters  is  very  lowering,  but  effect- 
ive therapeutical  results  may  be  obtained  without  this.  The  diet,  though 
restricted,  should  be  nourishing,  exercise  moderate,  not  exhausting,  and 
mental  and  bodily  rest  for  some  time  after  the  treatment  is  very  desira- 
ble. Baths  of  the  cooled  mineral  waters  are  often  beneficial,  but  are  less 
used  now  than  they  formerly  were. 

Marienbad,  also  in  Bohemia,  and  about  five  hours'  drive  from  Carls- 
bad, is  situated  in  a  broad  and  beautiful  valley,  about  nineteen  hundred 
feet  above  the  sea.  The  air  is  not  mild,  but  is  pure  and  dry,  "and  colds 
are  less  often  taken  here  than  at  Carlsbad."  The  season  begins  some- 
what earlier,  viz.,  at  the  beginning  of  May,  and  it  lasts  until  the  end  of 
September.  Marienbad  is  the  principal  representative  of  cold  gaseous 
sulphated  soda  waters,  and  the  springs  most  used,  the  Kreuz  and  the 
Ferdincmdsbrunnen,  are  stronger  than  the  Carlsbad  springs,  and  contain 
more  free  carbonic  acid.  They  are  more  aperient,  and  given  therefore  in 
smaller  doses  (one  to  six  tumblerfuls),  or  to  patients  who  need  more 
purging.  In  other  respects,  and  excepting  in  diabetes,  these  waters  are 
used  like  those  of  Carlsbad.  They  contain  some  iron,  which,  however,  is 
not  of  importance,  unless  in  the  Kronprinz- Rudolf  spring. 

The  Carolinen  and  Ambrosius  springs  are  gaseous,  weak  in  saline 
constituents,  but  containing  some  iron.  The  Marienbrunnen  is  used  for 
drinking  as  well  as  for  water  and  carbonic  acid  baths.  The  Moor  or  mud- 
baths  at  this  Spa  are  also  in  request,  and  are  prepared  with  black  mineral 
powder  brought  from  a  neighboring  peat-bed.  The  gas-baths  relieve 
myalgic  and  neuralgic  pain,  and  soothe  the  general  nervous  system,  while 
they  stimulate  that  of  the  uterus;  the  mud-baths  stimulate  the  skin  and 
promote  the  healing  of  ulcerations,  and  the  absorption  of  glandular  swell- 
ings. 

Franzensbad,  near  Edgar,  in  Bohemia,  thirteen  hundred  feet  above 
the  sea,  has  a  fresh  climate  and  good  arrangements.  The  waters  resem- 


MINERAL    WATERS    AND    BATHS.  163 

ble  those  of  Carlsbad,  but  are  colder,  and  have  more  carbonic  acid,  and 
also  more  sulphate  of  soda  (18  to  27  gr.,  with  chloride,  carbonate,  and 
some  iron).  The  treatment  at  this  Spa  has  always  been  milder  and  more 
stimulating  than  at  Carlsbad,  and  better  adapted  for  anaemic,  weak,  thin, 
and  perhaps  hypochondriacal  or  hysterical  subjects.  In  such  cases,  and 
especially  in  women  who  have  become  anaemic  with  spinal  irritation  and 
uterine  disorder,  benefit  is  obtained  here  when  stronger  and  more  pro- 
nounced chalybeates  would  not  agree.  Digestion  is  promoted,  the  nervous 
system  strengthened,  and  the  circulation  stimulated. 

Mud  and  gas  baths  are  also  much  used  here,  and  are  beneficial  in 
chronic  skin  disease  and  ulceration,  rheumatism,  gouty  deposits,  and  par- 
ah'ses  when  no  active  central  disease  is  present. 

Tarasp,  in  the  Lower  Engadine,  canton  Grisons,  situated  on  the  River 
Inn,  amid  fine  Alpine  scenery,  four  thousand  feet  above  the  sea,  has  re- 
cently risen  into  fashion,  and  is  one  of  the  most  interesting  and  valuable 
Spas.  The  rarefied  pure  air  acts  as  a  powerful  stimulant  or  tonic,  and 
the  summer  climate  is  temperate  and  pleasant,  while  the  conditions  of  life 
are  much  more  simple  than  at  Carlsbad,  Vichy,  Marienbad,  etc.  The  in- 
gredients of  the  waters  are  the  same  as  those  of  Franzensbad,  Marienbad, 
or  Carlsbad;  the  chief  springs  are  the  great,  or  St.  I/ucius,  spring,  and 
the  little,  or  St.  Emerita,  spring,  having  16  gr.  of  soda  sulphate,  29  gr. 
of  chloride,  about  40  gr.  of  bicarbonate,  17  gr.  of  lime,  7  gr.  of  magnesia, 
an  effective  proportion  of  iron,  and  a  large  amount  of  carbonic  acid. 

These  are  used  in  the  cases  already  described  as  suitable  for  Carlsbad 
and  Marienbad,  except  that  there  is  not  yet  an  equal  experience  as  to 
diabetes;  on  the  other  hand,  cases  of  bronchial  catarrh,  and  even  of 
tuberculosis  in  an  early  stage,  and  especially  when  complicated  with  hepa- 
tic troubles,  have  derived  much  advantage  at  Tarasp. 


CLASSZ  (e).- COMMON-SALT  WATERS. 

Hamburg,  in  Prussia,  about  nine  miles  from  Frankfort,  pleasantly 
situated  on  the  southern  slope  of  the  Taunus  Mountains,  six  hundred  feet 
above  the  sea,  has  a  fresh  and  bracing  climate  even  in  the  summer.  The 
Elizabethbrunnen  (the  most-used  spring)  contains  75  gr.  of  chloride  of 
sodium,  the  Kaiserbrunnen  55  gr.,  while  both  have  also  other  alkaline 
chlorides,  lime,  magnesia,  a  little  iron,  and  much  carbonic  acid,  at  a  tem- 
perature of  50°  F.  (cold).  The  Ludwigsbrunnen  contains  only  about 
half  the  amount  of  chlorides,  and  the  iMisenbrunnen  scarcely  any  calcium 
or  magnesium. 

The  two  springs  first  named  are  stronger  than  those  of  Kissingen,  and 
are  given  in  doses  of  two  to  four  tumblerfuls  in  cases  of  dyspepsia  and 
gastro-intestinal  catarrh,  constipation,  strumous  glandular  enlargement, 


164  MATERIA    MEDICA    AND   THERAPEUTICS. 

gout,  obesity,  hypochondriasis,  etc.  The  Luisenbrunnen  is  "very  suita- 
ble for  anaemia  and  Indian  cachexia." 

Kissingen,  about  thirty  miles  from  Wtirzburg,  and  six  hundred, feet 
above  the  sea,  in  the  pleasant  valley  of  the  Saale,  is  the  main  representa- 
tive of  cold,  moderately  strong  gaseous  salt  springs,  and  is  one  of  the 
most  fashionable  watering-places  of  Germany.  The  principal  springs 
are  the  Ragoczi,  the  Pandur,  and  the  Maxbrunnen  /  the  latter  is  a  very 
weak  salt  water;  the  other  two  are  nearly  equal  in  strength,  contain- 
ing more  than  40  gr.  of  chloride  of  sodium  with  small  quantities  of 
other  alkaline  chlorides,  4  gr.  of  sulphate  of  magnesia,  2  gr.  of  lime,  a 
trace  of  iron,  and  much  carbonic  acid  (40  to  48  cub.  in.);  the  tempera- 
ture is  51°  F.  (cold).  The  Ragoczi  is  generally  taken  in  the  morning 
(three  to  six  glasses);  the  Pandur,  being  somewhat  milder,  in  the  even- 
ing. They  quicken  the  circulation,  alter  and  stimulate  the  gastro-intes- 
tinal  secretions,  and  are  valuable  in  dyspepsia,  with  eructations,  flatu- 
lence, and  constipation,  in  some  gouty  and  calculous  cases,  in  moderate 
degree  of  hepatic  and  renal  congestion,  in  strumous  and  tubercular  en- 
largement of  glands,  etc. 

In  prescribing  salt  springs  for  cases  of  chronic  dyspepsia,  we  should 
bear  in  mind  that,  as  a  rule,  they  are  best  taken  cold,  because  a  high 
temperature  counteracts  the  intended  irritant  effects,  and  causes  too 
rapid  absorption  of  the  salt.  They  are  unsuitable  for  cases  of  excessive 
acidity  which  is  increased  by  chlorides.  The  water  should  not  be  con- 
centrated, and  the  dose  should  be  small,  and  carbonic  acid  much  assists 
its  digestion.  On  the  other  hand,  in  some  cases  of  gastric  catarrh,  the 
cold  waters  are  not  well  borne,  and  then  recourse  is  had  to  the  warm 
spring  of  Wiesbaden.  The  strong  salt  bath  of  the  Soolspmdel  is  much 
used,  but  Braun  objects  to  the  large  amount  of  carbonic  acid  given  off 
from  it  and  inhaled  by  the  lungs,  as  being  apt  to  cause  giddiness  and 
dyspnoea. 

Wiesbaden,  capital  of  the  former  Duchy  of  Nassau,  is  three  hundred 
and  twenty-three  feet  above  the  sea,  and  is  situated  beautifully  on  the 
southern  slope  of  the  Taunus  Mountains,  five  miles  northwest  of  May- 
ence.  The  climate  here  is  mild,  in  winter  being  one  of  the  warmest  in 
Germany;  in  spring  and  autumn  usually  fine;  but  at  midsummer  hot  and 
relaxing.  The  season  is  from  June  till  September.  The  principal  spring 
is  the  Kochbrunnen,  which  rises  like  a  boiling  well  at  150°  F.,  emitting 
clouds  of  steam.  Its  constituents  are  similar  to  those  of  the  Kissingen 
Ragoczi,  viz.,  chloride  of  sodium  (52  gr.  in  the  pound),  carbonate  of  lime 
(3  gr.),  and  traces  of  potash,  magnesia,  iron,  etc.  The  amount  of  car- 
bonic acid  is  much  less  (6  cub.  in.);  the  temperature  much  higher.  The 
amount  of  chloride  is  slightly  greater  than  that  at  Kissingen,  but  yet 
larger  doses  of  the  water  can  be  taken,  and  increased  intestinal  secretion 
less  often  occurs  from  it.  Hence  if  the  gastric  condition  does  not  espe- 


MINERAL    WATERS    AND    BATHS.  165 

cially  need  the  stimulus  of  cold,  the  warm  spring  is  to  be  preferred  when 
the  strong  effect  of  salt  on  the  blood  is  desired. 

In  cases  of  chronic  inveterate  gout  which  we  can  scarcely  hope  to 
cure,  but  which  we  can  benefit  by  moderate  increase  of  tissue-change 
while  keeping  up  nutrition,  these  springs  are  most  useful.  They  are 
useful,  also,  in  chronic  eruptions  with  hepatic  and  abdominal  congestion, 
and  in  chronic  rheumatism,  in  which  disorder  and  in  chronic  paralyses  the 
warm  saline  baths  are  specially  indicated. 

They  may  be  injurious  in  debility,  in  uterine  congestion,  and  in  ten- 
dency to  apoplexy  or  other  hemorrhagic  conditions. 

At  Wiesbaden  there  are  also  hydropathic  establishments,  and  the 
ophthalmic  hospital  of  Dr.  Pagenstecher. 

I?aden-J3aden,  six  hundred  and  sixteen  feet  above  the  sea,  is  situated 
in  a  beautiful  valley  of  the  Black  Forest,  six  miles  from  the  Rhine.  The 
air  is  pure  and  mild,  so  that  baths  can  be  taken  late  in  the  autumn,  and 
the  season  is  from  the  beginning  of  May  until  October.  The  general 
arrangements  are  agreeable,  and  the  influx  of  visitors  very  large.  Of  the 
numerous  springs,  only  the  Ursprungquelle  need  be  mentioned.  It  con- 
tains 18  gr.  of  chloride  of  sodium,  and  2£  gr.  of  lime  sulphate,  with  traces 
of  iron  carbonate,  but  very  little  free  carbonic  acid. 

Gout  and  rheumatism  of  only  moderate  severity,  dyspepsia,  and  im- 
paired nerve-condition  from  overwork,  etc.,  various  manifestations  of  the 
scrofulous  diathesis,  are  all  favorably  influenced  by  the  waters  of  Baden- 
Baden,  which  are  taken  internally  and  used  as  baths. 

Soden,  in  Nassau,  near  Frankfort,  four  hundred  and  forty  feet  above 
the  sea,  contains  many  tepid  salt  springs  varying  in  their  proportion  of 
chloride  from  18  to  109  gr.  The  amount  of  carbonic  acid  is  rather  large. 

The  climate  is  mild,  equable,  and  moist,  but  very  hot  in  summer. 
Besides  being  suitable  for  the  class  of  cases  already  mentioned,  Soden  has 
a  special  reputation  in  chronic  catarrhal  conditions,  with  or  without  ten- 
dency to  phthisis.  Near  at  hand,  at  Kronthal,  are  good  chalybeate 
springs,  and  the  bracing  health-resort  of  Falkenstein,  which  is  seventeen 
hundred  feet  above  the  sea,  well  wooded  and  sheltered  from  excessive 
sun  and  wind,  and  forming  a  good  residence  both  in  winter  and  summer 
for  the  earlier  stages  of  phthisis. 

Reichenhall,  in  Bavaria,  lies  in  a  sheltered  position,  near  fine  Alpine 
scenery,  and  has  a  mild  climate,  at  its  best  in  May  and  autumn — rainy  in 
the  summer.  Of  its  salt  springs,  the  Eddquelle  is  one  of  the  strongest  in 
Europe,  containing  23  per  cent,  chloride  of  sodium,  temperature  57°  F. 
The  waters  are  used  in  warm,  tepid,  douche,  and  wave-bath,  and  also  by 
inhalation,  patients  walking  between  large  hedges,  forty  feet  high,  made 
of  twigs,  on  which  the  salt  water  trickles  and  evaporates:  the  air  of  a 
large  room  is  also  kept  impregnated  with  salt  spray;  and  the  breathing 
of  such  air  for  a  limited  period  daily  is  found  useful  in  catarrhal  conditions 


166  MATERIA    MEDIC  A    AND    THERAPEUTICS. 

of  the  chest  and  stomach  (Burden  Sanderson:  Practitioner,  vol.  i.). 
There  are  similar  chambers  at  Kreuznach,  Rehme,  and  a  few  other  places. 

Kreuznach,  in  Rhenish  Prussia,  pleasantly  situated  in  the  Nahe  Val- 
ley, two  hundred  and  eighty-six  feet  above  the  sea,  "is  the  chief  of  sool- 
baths"  (Braun). 

The  climate  is  mild  in  the  early  spring  and  late  autumn,  hot  in  the 
summer.  The  season  extends  from  the  end  of  April  until  the  beginning 
of  October.  The  Elisenquelle,  or  Elizabethbrunnen,  contains  73  gr.  of 
chloride  of  sodium,  13  gr.  chloride  of  calcium,  4  gr.  chloride  of  magnesium 
traces  of  potassium,  lithium,  iron,  and  minute  quantities  of  bromide  and 
iodide  of  magnesium.  There  is  some  carbonate  of  lime  but  no  sulphate; 
no  carbonic  acid.  Temperature,  54.5°  F. 

The  water  of  the  Carlshalle,  and  Theodorshalle  is  weaker,  the  chloride 
of  sodium  being  59  gr.  and  57  gr.  respectively,  while  the  Oranienquelle 
has  108  gr.  of  the  sodium  salt,  and  22  gr.  of  chloride  of  calcium.  The 
waters,  which  are  bitter  and  rather  nauseous,  should  be  commenced  in 
small  doses,  and  are  often  taken  with  hot  milk.  The  Ellsenquelle  readily 
acts  on  the  bowels. 

The  warm  baths  at  Kreuznach  are  used  particularly  strong,  concen- 
trated brine,  or  "  mother-lye,"  being  often  added  to  the  natural  water, 
and  the  bath  being  prolonged  for  half  an  hour  or  an  hour.  This  "  mother- 
lye,"  according  to  the  degree  of  its  inspissation,  contains  in  each  pound, 
from  100  gr.  to  more  than  200  gr.  of  chloride  of  sodium,  from  1,000  to 
2,000  gr.  of  chloride  of  calcium,  from  200  to  300  gr.  chloride  of  magnesium, 
130  to  160  gr.  chloride  of  potassium,  some  iodide  of  sodium,  chlorides  of 
lithium  and  aluminum,  and  about  GO  gr.  of  bromide  of  sodium. 

The  justly  esteemed  Kreuznach  system  of  treatment  combines  the  use 
of  these  strong  baths  with  injections,  douches,  etc.,  and  drinking  of  the 
water — in  small  quantities,  if  a  generally  stimulating  effect  is  desired, 
but  in  large  doses  for  the  absorption  of  scrofulous  and  other  exudations. 
I  have  seen  much  advantage  from  it  in  congestion  and  chronic  inflamma- 
tion of  the  uterine  system,  in  hypertrophy  and  induration  of  the  uterus 
itself,  and  of  the  mammary  gland,  and  in  painful  irregular  menstruation 
connected  with  ovarian  hyperaemia.  It  relieves,  also,  the  local  congestion 
and  oedema  commonly  associated  with  uterine  fibroma,  and  I  believe  that 
it  even  procures,  sometimes,  the  absorption  of  such  growths  to  some  extent 
(v.  p.  119). 

Chronic  eruptions  and  scrofulous  ulcerations  also  receive  benefit  from 
Kreuznach  water,  and  the  local  use  of  the  "  mother-lye  "  to  distorted  gouty 
joints  has  sometimes  given  me  good  results. 

Braun  compares  with  Kreuznach  the  more  recent  Spa  of  Rehme  (CEyn- 
hausen),  which  is  situated  one  hundred  and  thirty-four  feet  above  the 
sea,  "  in  a  broad  and  fertile  valley  watered  by  the  Weserand  the  Werre," 
on  the  railway  between  Minden  and  Cologne.  The  climate  is  fresh  but 


MINERAL    WATERS    AND    BATHS.  167 

mild,  and  is  less  changeable  than  that  of  many  other  places;  the  water 
is  very  rich  in  chloride  (240  gr.),  and  contains  also  sulphate;  it  is  used 
principally  in  the  form  of  warm  bath,  and  differs  from  the  Kreuznach 
hath  mainly  in  the  large  amount  of  carbonic  acid  it  contains.  There  are 
also  carbonic  acid  baths  (v.  p.  187),  a  "wave-bath"  in  the  river  under  the 
mill,  and  a  large  chamber  filled  with  salt  spray  for  inhalation. 

Rehme  is  suitable  for  the  same  kind  of  cases  as  are  sent  to  Kreuznach, 
but  in  a  less  advanced  stage,  and  when  the  subjects  are  weaker,  and  too 
delicate  for  the  stronger  methods  of  the  latter  Spa.  Benefit  is  said  to  be 
obtained  from  the  baths  specially  in  retarded  convalescence  after  fever, 
fractures,  etc.,  in  general  debility,  anaemia,  tabes  dorsalis,  spinal  irritation, 
and  even  in  spinal  meningitis  and  paralysis.  The  spray  is  useful  in  ca- 
tarrhal  conditions  of  the  respiratory  tract. 

Kreuth  should  be  mentioned  as  an  example  of  a  high-situated  salt  Spa, 
being  nearly  three  thousand  feet  above  the  sea,  amid  Alpine  scenery, 
between  Munich  and  Salzburg.  It  is  sheltered  and  possesses  a  pure, 
rather  moist,  and  particularly  still  atmosphere. 

There  are  here  a  large  "  Kurhaus,"  a  "  whey-cure,"  and  strong  salt 
baths.  The  drinking  springs  contain  mainly  sulphates,  or  sulphur. 
Cases  of  irritable  mucous  membranes  of  scrofulous  or  tuberculous  char- 
acter are  often  benefited  at  this  place. 

Droitwich  is  a  small  salt-manufacturing  town,  six  miles  north  of  Wor- 
cester, and  fourteen  from  Malvern.  The  climate  is  mild  and  equable, 
rather  relaxing,  and  though  the  place  itself  is  uninviting,  there  is  fine  open 
country  in  the  immediate  neighborhood.  There  is  now  good  accommoda- 
tion for  bathing,  and  an  establishment  close  to  the  waters  under  the  di- 
rection of  Mr.  Bainbrigge. 

The  proportion  of  saline  ingredient  is  very  high — far  higher  indeed 
than  at  any  other  known  spring,  there  being  about  2,500  gr.  chloride  of 
sodium,  38  gr.  lime  sulphate,  and  39  gr.  soda  sulphate  in  each  pound  (D. 
T.  Taylor).  Used  for  bathing  at  about  95°  to  112°  F.,  these  waters  are 
stimulating  and  absorbent,  and  are  very  serviceable  in  relieving  pain  and 
exudations,  and  impaired  power  connected  with  chronic  rheumatic  and 
gouty  conditions;  also  in  lumbago  and  sciatica,  in  some  chronic  skin- 
eruptions,  as  psoriasis,  in  glandular  scrofulosis,  general  debility  after  ill- 
ness, etc.,  especially  when  this  is  associated  with  slow  circulation  and 
mental  depression;  serous  effusions  are  also  absorbed  under  their  use,  and 
they  are  said  to  have  proved  a  powerful  stimulant  and  restorative  during 
the  cholera  epidemic  of  1831.  Strong  brine  baths  can  be  used  at  a  high 
temperature  without  the  exhaustion  and  debility  that  follow  an  ordinary 
hot  bath. 

Woodhall  Spa,  near  Horncastle,  in  Lincolnshire,  has  a  dry  and  bracing 
climate,  and  is  sheltered  from  north  and  east  winds.  The  water  contains 
a  good  proportion  of  sodium  chloride  (120  gr.  in  the  pound),  21  gr.  of 


168  MATERIA    MEDIC  A    AND    THERAPEUTICS. 

calcic  and  other  chlorides,  and  also  about  £  gr.  of  bromide,  and  ^  gr. 
iodide  of  sodium. 

It  is  used  in  scrofulosis,  and  sometimes  in  chronic  gout  and  rheuma- 
tism. Half  a  pint  of  it  acts  as  a  mild  aperient. 

There  is  a  saline  spring  at  Harrogate,  somewhat  similar  to  one  at 
Kissingen,  and  called  the  "  Kissingen  water."  It  has  more  lime  and  less 
carbonic  acid,  and  is  moderately  aperient.  Most  of  the  sulphur  waters 
also  contain  a  large  proportion  of  chloride. 


CLASS  3.—  SULPHUR  WATERS. 

The  sulphur  baths  of  the  Pyrenees  have  been  famous  from  an  early 
period.  Most  of  them  are  natural  baths  (Wildbader),  in  high  mountain- 
ous situations,  and  with  a  rough  climate. 

Eaux-bonnes,  department  Basse-Pyrenees,  two  thousand  three  hun- 
dred feet  above  the  sea,  situated  in  a  narrow  sheltered  ravine  at  the  foot 
of  the  Pic  du  Gers,  about  twenty  miles  from  Pau,  is  rich  in  grand  natural 
beauties,  and  has  a  remarkably  pure  fresh  climate,  though  it  is  subject  to 
great  changes  of  temperature  during  the  day. 

The  waters  contain  0.18  cub.  in.  sulphuretted  hydrogen  to  the  pint, 
with  but  2  gr.  chloride  of  sodium,  and  2  gr.  of  other  salts,  sulphates,  and 
iodides,  at  a  temperature  of  90°  F. 

The  dose  at  first  taken  is  but  small,  often  a  tablespoonful,  but  this  is 
increased  gradually  to  a  pint  or  more,  and  the  good  results  are  said  to  be 
so  remarkable  in  tuberculosis  and  pneumonic  consolidation  of  lung,  in 
asthma,  granular  pharyngitis,  pleuritic  effusion,  and  scrofulous  deposits, 
as  well  as  in  chlorosis,  amenorrhcea,  and  atonic  dyspepsia,  that  many 
physicians  "  have  supposed  the  cures  to  be  due  to  some  as  yet  unknown 
element  in  the  otherwise  very  poor  water."  The  high  situation  of  the 
Spa  is  probably  a  main  agent  in  its  action.  The  season  lasts  from  June 
to  mid-September,  and  residence  is  usually  arranged  for  a  month  at  a  time 
during  one  or  two  seasons.  Bathing  is  not  much  practised,  but  the  pa- 
tient is  recommended  to  live  as  much  as  possible  in  the  open  air,  and  to 
complete  the  treatment  by  a  course  of  sea-bathing  at  Biarritz. 

Eaux-chaudes,  situated  four  miles  further  on  in  the  same  valley,  has 
water  containing  sulphuret  of  sodium,  sulphate  of  lime,  etc.,  which  are 
aised  more  for  baths  than  for  drinking,  in  muscular  rheumatism,  neural- 
gias, chlorosis,  etc. 

Ponticosa,  in  Arragon,  a  day's  journey  from  Eaux-chaudes,  is  situ- 
ated in  a  valley  of  the  Pyrenees,  nearly  six  thousand  feet  above  the  sea. 
The  waters  contain  much  nitrogen  and  sulphuretted  hydrogen,  with 
chlorides  and  sulphates.  They  increase  the  secretions  and  the  appetite, 
but  without  exciting  the  circulation.  They  relieve  the  cough  of  laryngeal 


MINERAL   WATERS    AND   BATHS.  169 

phthisis  and  bronchial  irritation,  and  are  suitable  for  cases  of  haemoptysis, 
but  not  for  softening  tubercle.     The  best  months  are  July  and  August. 

Cauterets,  department  Hautes  Pyrenees,  three  thousand  two  hundred 
feet  above  the  sea,  in  a  narrow  winding  valley,  has  a  pure  and  fresh,  but 
rather  variable  climate.  It  contains  more  than  thirty  warm  saline  sulphur- 
etted springs,  some  of  which  are  highly  stimulating,  and  give  rise  to  fe- 
verishness  and  headache.  The  Raittere,  which  is  famous  for  the  cure  of 
chronic  bronchial  catarrh,  contains  in  one  pound  only  0.14  gr.  sulphuret 
of  sodium,  0.3  gr.  sulphate  of  soda,  0.3  gr.  chloride  of  sodium,  0.4  gr. 
silica,  nitrogen,  and  traces  of  sulphuretted  hydrogen,  but  the  water  is 
very  warm  (102°  F.).  It  is  used  both  internally  and  by  bath,  and  some- 
times gives  strikingly  good  results  in  early  stages  of  phthisis  and  stru- 
mous  deposit,  in  gastric  catarrh,  uterine  congestions  and  fluxes,  also  in 
chronic  rheumatism  and  skin  diseases.  Animals,  especially  horses,  with 
catarrh  or  abnormal  discharges,  are  also  benefited  at  Cauterets.  July, 
August,  and  September  are  the  best  months. 

Bareges,  department  Hautes  Pyrenees,  four  thousand  feet  above  the 
sea,  with  a  bracing  rough  climate,  is  "  the  most  famous  of  Pyrenean  Spas." 
The  sulphurous  stimulating  waters  are  hot  (107°  F.,  Sain  cle  VEntree), 
warm  (98°  F.),  and  tepid  (84°).  They  are  limpid,  have  an  oily  nauseous 
taste,  characteristic  odor,  and  contain  nitrogen  and  sulphuretted  hydro- 
gen, with  small  quantities  of  sulphuret,  sulphate,  and  chloride  of  sodium, 
etc.  On  their  surface  is  found  a  gelatinous  pellicle  called  baregine  or 
glairine,  which  is  a  nitrogenous  organic  substance,  found  in  most  sulphur 
waters,  emollient,  and  supposed  to  be  efficacious  in  chronic  rheumatism. 
Sufferers  from  this  complaint,  and  from  sciatica,  lumbago,  and  stiffness  of 
muscles  and  tendons,  visit  Bareges  in  large  numbers;  it  is  celebrated  also 
in  paralysis,  in  strumous  ulcerations,  and  especially  in  bone  disease  and 
old  gun-shot  wounds.  The  swimming-baths  are  much  used,  and  the  waters 
are  taken  internally.  They  are  not  suitable  for  "irritable  nervous  subjects, 
nor  in  heart  disease,  nor  tendency  to  inflammatory  disorder"  (Tanner). 
The  season  extends  from  early  in  June  to  mid-September.  In  July  and 
August  the  crowding  is  sometimes  so  great  that  "  invalids  must  leave 
their  beds  soon  after  midnight  for  their  turns  at  the  baths,  and  the  air  in 
the  'piscines,'  from  the  small  space  allowed  to  each  bather,  is  almost  in- 
tolerable "  (H.  Weber). 

Saint  Sauveur,  four  miles  from  Bareges,  has  similar,  but  milder  waters, 
which  are  much  used  by  women  and  children  for  hysteria,  neuralgia,  leu- 
corrhoea,  and  uterine  derangements — "  pre-eminently  the  French  ladies' 
Spa"  (Braun).  The  season  begins  earlier,  and  lasts  later  than  at  Bare- 
ges. 

Bagneres  de  Luchon,  department  Haute  Garonne,  two  thousand  feet 
above  the  sea,  is  charmingly  placed  in  a  broad  valley,  close  to  splendid 
scenery,  enjoys  a  mild  climate,  has  excellent  arrangements  for  recreation 


170  MATERIA   MEDICA    AND    THERAPEUTICS. 

and  abundant  sulphurous  water,  double  the  strength  of  those  already 
mentioned.  There  are  about  fifty  springs,  varying  in  temperature  from 
63°  to  132°  F.,  and  containing  sulphuret  and  sulphate,  sulphite,  and  chlo- 
ride of  sodium,  other  sulphurets,  silica,  lime,  etc.  Analysis  detects  only 
traces  of  sulphuretted  hydrogen  in  the  waters  at  the  springs,  but  almost 
as  soon  as  drawn,  they  become  milky  on  account  of  some  decomposition 
with  development  of  this  gas,  and  so  much  of  it  escapes  from  the  large 
bath  that  the  atmosphere  above  it  contains  more  than  1  per  cent.  They 
are  used  in  the  same  cases  as  Bareges  and  Cauterets,  etc. 

A.ix-les- Bains,  in  Savoy,  near  Chambery,  seven  hundred  and  ninety 
feet  above  the  level  of  the  sea,  in  a  sheltered  picturesque  valley  of  the 
Alps,  is  a  celebrated  watering-place — the  Agnse  Gratinas  of  the  Romans 
— greatly  resorted  to  for  its  sulphurous  springs,  which  are  often  of  much 
value  in  chronic  rheumatism,  gout,  neuralgia,  and  some  skin  diseases,  as 
well  as  in  paralysis.  The  temperature  of  the  water  varies  from  100°  to 
117°  F.  They  are  chiefly  employed  for  baths,  the  douche-bath  being  the 
one  most  in  use.  The  hot  water  is  made  to  fall  in  streams  from  a  height 
of  about  8  to  10  feet  upon  the  patient,  who  is  afterwards  thoroughly 
rubbed,  wrapped  in  blankets,  sent  home  in  a  sedan-chair,  and  then  put 
to  bed.  The  climate  is  mild  and  relaxing.  During  the  season  the  place 
is  often  unpleasantly  crowded. 

Aix-la-Chapelle,  five  hundred  and  thirty-four  feet  above  the  sea,  is 
the  principal  German  sulphur  bath.  "  The  amount  of  sulphuret  of  sodi- 
um in  the  springs  is  small,  compared  with  the  Pyrenean  baths,  but  the 
sulphate  of  soda  is  rather  more,  also  the  sulphuretted  hydrogen,  and  in 
addition,  there  are  20  gr.  of  chloride,  and  5  gr.  of  carbonate  of  soda,  with 
traces  of  iodide  and  bromides.  This  combination  is  of  much  importance 
for  drinking  "  (Braun).  The  temperature  of  the  water  taken  internally 
is  often  130°  F. 

Warm  baths  (95°  F.),  prolonged  from  half  to  three-quarters  of  an 
hour,  are  also  much  used  at  Aix,  with  vapor  baths,  douches,  and  frictions, 
and  the  results  of  the  combined  treatment  are  very  satisfactory  in  rheu- 
matism, gout,  chronic  eruptive  disorders,  acne,  psoriasis,  and  abdominal 
plethora;  they  are  often  good,  though  not  so  markedly,  in  paralyses, 
metallic  poisoning,  and  chronic  syphilis,  but  Braun  throws  scientific 
doubt  upon  the  supposed  special  efficacy  of  the  sulphur  in  these  maladies, 
and  connects  the  therapeutics  more  with  the  temperature  and  the  amount 
of  saline  liquid.  Mercury  is  also  commonly  used  in  the  treatment  of 
syphilis  at  Aix,  not  internally,  but  by  inunction  of  mercurial  ointment, 
from  1  to  1£  dr.  being  used  daily  after  a  warm  bath.  The  value  of  the 
baths  and  water  in  the  treatment  of  this  disorder  lies  in  their  (1)  increas- 
ing the  specific  action  of  mercury;  (2)  preventing  salivation  and  other 
injurious  effects  of  the  drug;  (3)  keeping  the  skin  in  an  active  state,  the 
glands  secreting,  and  the  pores  free.  The  patients  are  directed  to  live 


MINERAL    WATERS    AND    BATHS.  171 

well,  eat  freely  of  animal  food,  drink  wine,  and  to  be  constantly  in  the 
open  air.  Rheumatoid  arthritis  is  also  treated  with  some  success  at  Aix. 
The  season  begins  early  in  June,  and  ends  in  September.  As  the  treat- 
ment is  highly  stimulating,  it  is  not  suitable  for  apoplectic  and  hemor- 
rhagic  cases. 

Weilbach,  in  the  Prussian  province  of  Nassau,  in  the  valley  of  the 
Main,  on  the  eastern  slope  of  the  Taunus  range,  has  a  good  sulphurous 
spring  for  internal  use,  the  quantity  of  sulphuretted  hydrogen  amounting 
to  0.16  cub.  in.  Carbonic  acid  is  also  present;  the  amount  of  salts  is 
small,  a  few  grains  only  of  chlorides  and  carbonates  of  soda,  magnesia, 
and  lime.  "  The  life  here  is  quiet,  and  almost  solitary."  This  Spa  is 
specially  indicated  in  some  cases  of  lung  disease,  catarrhal  or  tubercular, 
when  hypersemic  enlargement  of  liver  exists,  or  congestion  of  the  abdom- 
inal viscera  with  hasmorrhoidal  tendency,  and  it  will  sometimes  relieve 
when  Carlsbad  and  other  soda  springs  cannot  be  borne.  Roth  has  given 
reasons  for  believing  that  sulphuretted  hydrogen,  taken  in  solution  into 
the  stomach,  acts  directly  on  the  blood  in  the  portal  vein,  forming  a  sul- 
phuret  with  the  iron  of  effete  blood-corpuscles,  and  thus  hastening  their 
destruction,  for  the  diminution  of  swelling  in  the  liver  under  the  influ- 
ence of  Weilbach  waters  is  accompanied  by  a  darker  and,  at  length, 
black  coloring  of  the  faeces,  in  which  a  large  amount  of  sulphuret  of  iron 
is  found.  This  does  not  come  from  the  water  (which  contains  none  of  the 
metal),  but  either  from  the  food  or  the  blood,  and  in  favor  of  its  being  from 
the  latter  is  the  fact  that,  as  the  liver  decreases  in  size,  an  anaemic  condi- 
tion manifests  itself  in  spite  of  plentiful  nutrition.  Roth,  indeed,  insists 
upon  full  meat  diet  during  a  course  of  these  waters,  and  a  chalybeate 
course  is  frequently  required  afterward.  Dr.  Braun  agrees  with  these  state- 
ments, and  himself  derived  much  benefit  from  the  waters  when  suffering 
from  haemoptysis  connected  with  "  hsemorrhoidal  enlargement  of  the  liver." 

Generally  they  have  rather  a  constipating  effect,  and  do  not  increase 
the  intestinal  secretions  like  sulphate  of  soda  waters,  though  irritation 
and  diarrhoea  may  be  occasionally  excited.  The  refreshing  feeling  and 
appetite  caused  by  saline  gaseous  waters  are  not  felt  at  the  time  of  drink- 
ing these  waters,  but  real  hunger  occurs  in  the  course  of  the  treatment. 
Besides  their  medicinal  use,  already  mentioned,  in  bronchial  catarrh,  etc., 
they  are  valuable  in  chronic  metallic  poisoning. 

BRITISH  SULPHUK  SPRINGS. — Harrogate,  about  thirty  miles  west  of 
York,  is  situated  part  on  high  level  ground,  about  six  hundred  feet  above 
the  sea,  and  part  in  a  sheltered  valley.  It  is  surrounded  by  open  and  pleas- 
ant country,  and  has  a  pure  and  bracing  though  rather  moist  air;  the 
sandy  soil  soon  dries  after  rain.  The  old  sulphur  well  and  the  strong 
Montpelier  sulphur  well  are  said  to  contain  25  cub.  in.  of  sulphuretted 
hydrogen  in  a  gallon  of  water,  with  alkaline  and  earthy  chlorides  and  sul- 
phides, and  traces  of  bromide  and  iodide. 


172  MATERIA    MEDICA    AND    THERAPEUTICS. 

They  are  alterative,  stimulant,  diuretic,  and  aperient,  and  are  taken 
in  doses  of  from  one  to  three  tumblerfuls,  at  intervals  before  breakfast. 

Milder  sulphurous  springs  at  the  Victoria  and  Montpelier  Gardens  are 
also  in  use.  They  contain  carbonate  of  magnesia,  and  are  "  antacid,  al- 
terative, diuretic,  and  deobstruent."  Both  these  waters  are  naturally 
cold,  but  are  commonly  taken  warm;  they  are  used  also  for  bathing,  the 
arrangements  for  which  are  very  good.  There  are  also  saline  chalybeate 
and  pure  chalybeate  waters.  The  social  resources  of  Harrogate  and  the 
pleasant  climate  of  summer  and  autumn  (June  till  October)  attract  many 
classes  of  invalids,  but  the  most  suitable  cases  for  treatment  by  the  waters 
are — dyspepsia  with  inactivity  of  liver  and  bowels,  especially  when  due  to 
high  living;  constipation,  obesity,  swelling  of  joints  and  glands,  chronic 
skin  diseases,  gout  and  rheumatism,  syphilis,  etc. ;  cases  of  incipient 
phthisis  and  disordered  menstruation  in  young  women  are  also  sent  here 
with  advantage,  and  make  use  of  the  warm  sulphur  baths  while  taking  the 
chalybeate  internally. 

Moffat,  in  the  upper  part  of  Annandale,  is  four  hundred  feet  above 
the  sea,  with  a  good  climate  and  picturesque  surroundings.  The  water, 
which  is  cold,  contains  2^  cub.  in.  sulphuretted  hydrogen  in  the  pint  with 
22  gr.  of  chloride,  and  2  gr.  of  sulphate  of  soda.  It  is  used  internally  in 
much  the  same  cases  as  the  Harrogate  sulphur  water. 

Strathpeffer,  in*  a  beautiful  part  of  Ross-shire,  has  several  cold  sulphur 
springs,  containing  a  good  proportion  of  the  gas  with  alkaline  and  earthy 
sulphates  and  16  gr.  of  lime  salts;  these  latter  render  the  water  some- 
what difficult  of  digestion,  and  constipating. 

At  Llandrindrod,  in  Radnorshire,  there  are  sulphur  wells  of  some 
reputation,  described  by  Macpherson  as  "  mild  Harrogate  waters."  At 
JSuilth  (the  next  railway  station)  there  is  a  weak  sulphur  well,  and  a 
saline  with  66  gr.  of  chloride;  and  at  Llanwityd  there  is  a  weak  saline 
spring  with  a  large  proportion  (0'62)  of  sulphuretted  hydrogen.  The 
climate  at  these  places  is  pure  and  bracing. 

The  principal  sulphur  wells  in  Ireland  are  at  JJisdoonvarna,  situated 
in  a  bare  country,  about  twenty  miles  from  Ennis  (county  Clare).  They 
are  said  to  contain  £  cub.  in.  of  sulphuretted  hydrogen,  and  are  much 
used,  but  the  accommodation  is  insufficient.  There  are  also  chalybeate 
springs  of  good  quality. 

GLA8B  4.—  EARTHY  MINERAL  WATERS. 

Wildungen,  in  the  principality  of  Waldeck,  is  seven  hundred  and  forty 
feet  above  the  sea,  and,  besides  a  chalybeate,  has  three  earthy  springs. 

The  Georg-  Victorquelle  is  a  strongly  acidulated  spring  containing  33 
cub.  in.  of  free  carbonic  acid,  with  5  gr.  of  carbonates  of  lime  and  mag- 
nesia, a  little  alkaline  sulphate,  silica,  and  iron.  The  Helenenquelle,  with 


MINERAL    WATERS    AND   BATHS.  173 

34  cub.  in.  of  carbonic  acid,  has  nearly  10  gr.  of  the  earthy  salts,  with  8 
gr.  of  chloride  of  sodium  and  bicarbonate,  and  a  trace  of  iron.  The 
Thalquette,  similar  to,  but  weaker  than  the  Helenenquelle,  is  more  used. 
It  exerts  an  antacid  and  diuretic  effect,  and  the  two  other  springs  show 
this  in  a  more  marked  degree,  They  are  prescribed  in  vesical  catarrh 
and  uric  acid  concretions  in  the  kidney,  and  may  be  either  continued  alone 
for  a  long  time,  or  conjoined  with  Carlsbad,  Vichy,  or  other  more  purely 
alkaline  waters. 

Leuk  (LenJcerbad,  Loeche-les- Bains},  on  the  north  bank  of  the 
Rhone,  in  the  canton  Wallis,  at  the  foot  of  the  Gemmi  Pass,  is  four 
thousand  six  hundred  and  seventy  feet  above  the  sea.  The  principal 
spring,  the  Lorenzquette,  contains  10  gr.  of  lime  sulphate  in  the  pound, 
with  some  magnesia  and  traces  of  alkalies  and  iron.  It  is  used  internally 
in  doses  of  one  to  five  tumblerfuls  taken  at  a  high  temperature  (122°  F.), 
and  is  rather  constipating,  but  diuretic  and  diaphoretic.  Braun  attributes 
more  importance  to  the  warm  fluid  than  to  the  ingredients. 

But  the  speciality  of  Leuk  is  the  mode  of  bathing.  There  are  four 
public  pools;  each  three  or  four  feet  deep,  and  accommodating  about  forty 
bathers,  who,  clothed  in  flannel,  amuse  themselves  with  conversation, 
games,  etc.,  and  spend  the  greater  part  of  the  day  in  the  warm  mineral 
water.  The  time  is  gradually  extended  from  half  an  hour  to  five  and  even 
eight  hours  in  the  day  for  about  ten  days,  and  then  gradually  diminished 
in  the  same  proportion,  so  that  a  course  is  completed  in  about  twenty-five 
days.  The  diseases  thus  treated  include  gouty  and  rheumatic  exudations, 
visceral  enlargements,  scrofulous  and  other  ulcerations,  and  chronic  erup- 
tions, such  as  psoriasis,  eczema,  and  prurigo.  In  such  cases  the  lime  sul- 
phate acts  as  a  local  stimulant,  and  often  causes  an  erythematous  or  pus- 
tular eruption  (poussee),  which  is  the  signal  for  diminishing  the  baths. 
The  high  situation  of  the  Spa  enables  such  stimulating  treatment  to  be 
better  borne  than  it  would  be  elsewhere. 

Weissenburg,  in  the  canton  Berne,  near  Thun,  two  thousand  seven 
hundred  and  fifty  eight  feet  above  the  sea,  is  situated  in  a  narrow  shel- 
tered ravine  surrounded  by  mountains  and  pine  trees.  The  air  is  calm, 
mild,  and  moist,  but  the  weather  variable;  the  mode  of  life  is  simple. 
The  waters  are  similar  to  those  of  Leuk,  but  with  more  lime  sulphate 
(17  gr.)  and  magnesia,  much  less  carbonic  acid;  temperature,  74.8°  F. 
Excellent  results  in  bronchial  catarrh  and  some  forms  of  phthisis  are  ob- 
tained at  Weissenburg,  but  are  to  be  explained  rather  by  its  general  con- 
ditions than  by  the  composition  of  the  water  (Braun).  Pleuritic  exuda- 
tions are  said  to  be  rapidly  absorbed.  The  waters  purge  in  full  doses 
(six  to  eight  glasses),  and  sometimes  cause  dyspepsia  at  first.  Baths  are 
not  used  in  phthisical  cases  (Rohden). 

Lippspringe,  a  small  town  near  Paderborn,  four  hundred  and  forty- 
one  feet  above  the  sea,  on  a  soil  of  chalk  and  sand,  has  a  lime  spring  con- 


174  MATERIA    MEDICA    AND    THERAPEUTICS. 

taining  5  gr.  of  sulphate  and  2  gr.  of  carbonate,  with  some  sulphate  of 
soda  and  magnesia,  a  little  iron,  some  carbonic  acid,  oxygen,  and  nitrogen, 
the  latter  in  comparatively  large  proportion  (1.4  cub.  in.);  temperature, 
70°  F.  Small  doses  (12  oz.)  constipate,  medium  quantities  regulate  the 
digestion,  while  30  to  36  oz.  commonly  relax  the  bowels.  It  is  remarkable 
that  under  treatment  at  this  place,  the  appetite  and  assimilative  power  of 
phthisical  patients  in  an  advanced  stage  have  improved  so  much  as  to  lead 
to  an  increase  in  weight  of  "  10  Ibs.  in  four  weeks,  and  21  Ibs.  in  thirteen 
weeks."  Whatever  the  explanation,  it  would  seem  that  the  diseased  lung- 
tissue  is  gradually  expectorated  during  the  treatment,  with  slight  fever  and 
moderate  suppuration,  so  that  the  cavities  heal  up,  and  a  cure  may  be  com- 
pleted at  higher  and  drier  health-resorts.  Possibly  the  heat  of  the  water 
and  its  slight  amount  of  gas,  taken  fasting,  facilitate  expectoration  and 
assist  in  the  softening  of  cheesy  deposit  and  loosening  of  catarrh  (Roh- 
den).  Possibly,  also,  the  moisture  of  the  atmosphere  assists  by  keeping 
in  the  water  of  the  lungs  and  skin;  the  climate  is  very  equable  and  cool; 
moist  west  winds  prevail;  the  noons  are  cooler,  and  the  mornings  and 
evenings  warmer  than  in  other  places  of  the  same  latitude.  Inhalations 
of  nitrogen  are  also  used  here. 

Inselbad,  near  Paderborn,  is  commonly  mentioned  with  Lippspringe 
as  a  resort  for  phthisical  subjects,  on  account  of  the  nitrogen  in  its  medi- 
cinal waters.  The  gas  is  also  inhaled.  The  weak  salt  spring  (6  gr. 
chloride,  with  2  gr.  lime  carbonate)  is  considered  valuable  in  haemoptysis 
(Horling). 


CLASS  5.—  "  INDIFFERENT  THERM^"  or  BATHS  WITHOUT  ACTIVE 
CHEMICAL  INGREDIENTS. 

JBuxton,  about  thirty  miles  north  of  Derby,  is  situated  on  a  lime-stone 
mountain  range,  nine  hundred  feet  above  the  sea.  The  air  is  pure  and 
bracing,  but  subject  to  sudden  variation,  and  the  rainfall  is  rather  large. 
The  season  extends  from  April  to  November,  but  June  is  generally  soon 
enough  for  a  visit,  for  there  are  cold,  sharp  winds  in  the  early  spring,  as 
well  as  in  late  autumn  and  winter.  The  quantity  of  solids  contained  in 
the  mineral  water  is  not  more  than  2  gr.  (lime,  etc.),  in  16  oz.  (Lyon 
Playfair);  the  gas  obtained  from  it  consists  of  about  99  parts  per  cent, 
of  nitrogen,  1  of  carbonic  acid,  and  a  trace  of  oxygen.  Temperature, 
82°  F. 

The  water  is  taken  internally,  but  used  mostly  for  bathing  at  the  nat- 
ural temperature  for  about  five  minutes,  and  at  a  raised  temperature 
(93°  to  96°  F. )  for  fifteen  minutes  (Robertson).  The  plunge,  swimming, 
and  douche-baths  are  very  good.  A  course  at  Buxton  is  often  beneficial 
in  gout  and  rheumatism,  especially  when  of  a  chronic  character;  also  in 
old  sprains  and  muscular  contractions,  and  in  debility,  "  when  the  vascu- 


MINEEAL    WATERS    AND    BATHS.  175 

lar,  nervous,  or  digestive  systems  require  stimulating."  It  is  unsuitable 
for  hemorrhagic  cases.  Dr.  H.  Weber  compares  Buxton  to  Schlan- 
genbad. 

Bath,  Somersetshire,  has  four  warm  mineralized  springs  in  the  south- 
ern part  of  the  town,  varying  in  temperature  from  104°  to  120°  F.  The 
solid  contents  amount  to  about  10  gr.,  in  the  pound,  of  alkaline  and  earthy 
salts,  with  a  little  silica  and  iron.  Nitrogen  exists  in  rather  large  quantity, 
and  oxygen  and  carbonic  acid  in  small  amount.  From  a  half  to  two 
tumblerfuls  are  taken  once  or  twice  daily,  with  the  usual  effect  of  slightly 
raising  temperature,  quickening  circulation  and  appetite,  and  promoting 
secretion.  Sometimes,  however,  headache,  depression,  and  pyrexia  occur. 

The  accommodation  for  bathing  is  very  good,  and  is  available  the 
whole  year,  but  the  greater  number  of  visitors  go  between  November  and 
April,  for  the  climate  is  relaxing  in  the  summer;  at  other  times  it  is  mild 
and  equable.  Cases  of  gout  and  rheumatism  of  moderate  severity,  neural- 
gia and  myalgia,  contracted  joints,  etc.,  some  dyspepsias,  rheumatic  or 
metallic  palsies,  leucorrhoea,  and  chronic  skin  diseases,  as  psoriasis  and 
eczema,  often  receive  benefit  at  Bath.  I  have,  however,  seen  much  irrita- 
tion in  several  cases  of  subacute  eczema  sent  to  these  baths,  and  there 
seem  to  be  many  nervous  irritable  subjects  with  whom  they  do  not  agree. 
It  has  been  called  the  English  Teplitz. 

Teplitz,  in  Bohemia,  six  hundred  and  forty-eight  feet  above  the  sea, 
with  agreeable  surroundings,  and  a  moderately  good  but  changeable  cli- 
mate, is  one  of  the  most  frequented  Spas  in  Europe,  having  arrangements 
for  four  thousand  baths  a  day.  They  are  generally  given  very  warm,  105° 
to  109°  F.,  and  followed  by  one  to  two  hours'  gentle  perspiration  in  bed. 
They  are  highly  stimulating  and  rather  predispose  to  catching  cold;  a 
subsequent  course  of  sea-bathing  increases  their  value,  which  is  certainly 
great  in  many  cases  of  gout  and  rheumatism. 

Plombieres,  in  the  Vosges,  in  a  deep  and  narrow  valley,  one  thousand 
three  hundred  feet  above  the  sea,  is  "  the  French  Teplitz."  The  springs 
are  but  slightly  mineralized,  but  are  very  warm  (143°  F.).  The  water  is 
taken  especially  in  chronic  gastralgia  and  catarrh  of  the  stomach,  and  the 
hot  baths  are  used  much  in  the  same  manner  as  at  Teplitz,  but  are  com- 
monly more  prolonged. 

Pf offers  and  Ragatz,  in  the  canton  St.  Gall,  have  also  indifferent  ther- 
mse  of  the  same  character.  The  former,  in  a  narrow  ravine,  two  thousand 
feet  above  the  sea,  has  warmer  baths,  but  is  much  less  pleasantly  situated 
than  the  latter  place,  which  lies  in  a  broad  bright  valley  five  hundred  feet 
lower  down.  The  waters  are  taken  in  four  tumblerfuls,  and  the  baths  used 
for  half  an  hour  twice  daily,  in  nerve-irritability,  neuralgia,  hysteria,  etc. 
Season,  May  to  September. 

Gastein,  a  few  hours'  drive  from  Salzburg,  in  a  beautiful  part  of  the 
Tyrol,  is  one  of  the  highest  baths,  being  three  thousand  three  hundred  feet 


176  MATERIA   MEDICA    AND    THERAPEUTICS. 

above  the  sea-level.  "  The  houses  are  grouped  round  the  edge  of  a  mountain 
torrent,  which  forms  a  splendid  waterfall,"  and  are  surrounded  by  grand 
and  mountainous  scenery.  The  climate  is  bracing,  and  rather  rough  and 
rainy,  but  not  so  variable  as  at  other  mountainous  resorts.  The  social  tone 
is  monotonous  and  quieting  for  excitable  subjects.  The  waters  are  clear 
and  soft,  temperature  96°  to  114°,  and  slightly  mineralized — one  pound 
contains  only  2£  gr.,  and  more  than  half  of  this  is  sulphate  of  soda;  they 
are  used  in  warm  baths  for  from  ten  minutes  to  an  hour.  The  methods 
in  use  at  Gastein  are  milder  than  at  Teplitz,  though  there  are  some  similar 
very  hot  baths  for  rheumatic  exudations  and  atonic  paralysis.  The  place 
has  a  high  reputation  in  such  cases,  also  in  hysteria,  hypochondriasis,  and 
impotence.  If  the  last-named  condition  be  due  to  over-excitability  of 
the  lumbar  cord  from  sexual  excess,  it  may  be  relieved  by  sedative  baths; 
but  if  from  spinal  paralysis,  it  is  not  likely  to  be  so,  and  hence  very  con- 
tradictory results  have  been  recorded  by  different  physicians  (Braun). 
Sometimes  the  cold  water  system,  or  that  of  Rehme  or  Schlangenbad, 
will  succeed  better.  It  is  especially  suited  for  slight  cases  of  spinal  con- 
gestion or  weakness,  marked  by  fatigue  on  slight  exertion  and  referred 
especially  to  the  lower  spine,  by  a  sense  of  weight  or  slight  anaesthesia, 
ataxia,  or  startings  after  much  walking  or  standing,  sometimes  irritability 
of  bladder — such  symptoms  may  be  quite  removed  by  a  comparatively 
short  course. 

Wildbad,  in  the  Wurtemburg  Black  Forest,  one  thousand  three  hun- 
dred and  thirty  feet  above  the  sea,  is  situated  in  a  beautiful  richly  wooded 
but  narrow  valley,  and  from  its  excellent  arrangements  has  become  a 
fashionable  bath  in  spite  of  a  somewhat  variable  climate.  The  waters  are 
soothing  and  refreshing,  and  are  used  externally,  especially  in  paralytic 
cases. 

Schlangenbad  is  close  to  Weisbaden  and  to  Schwalbach,  in  a  pleasant 
valley,  nine  hundred  feet  above  the  sea,  with  a  mild,  fresh,  and  equable 
climate,  and  is  well  suited  for  securing  the  sedative  tonic  results  of  ther- 
mal treatment.  The  arrangements  are  not  on  a  large  scale,  but  are  ex- 
cellent, the  life  quiet,  and  the  surrounding  forests  offer  varied  and  shel- 
tered walks  in  summer,  from  June  till  August.  The  waters  contain  only 
a  few  grains  of  soda,  lime,  and  magnesia,  at  81°  to  86°  F.  They  are  used 
chiefly  in  the  form  of  warm  baths  at  87°  to  92°  in  tabes  and  spinal  con- 
gestions, and  for  allaying  nervous  irritability.  Mud-baths  are  also  em- 
ployed for  the  same  purpose  and  for  improving  the  skin-condition. 

CLASS  6.— CHALYBEATE  WATERS. 

Protocarbonate  of  iron,  or  ferrous  carbonate,  is  contained  in  a  large 
number  of  mineral  waters,  in  amount  varying  from  mere  traces  to  several 
grains  in  16  oz.  The  most  used  and  the  most  successful  contain  between 
0.3  to  0.9  gr.,  with  free  carbonic  acid. 


MINERAL    WATERS   AND   BATHS.  177 

It  is  a  truism  that  minute  quantities  of  iron  taken  at  mineral  springs, 
with  the  advantages  of  change,  pure  air,  and  often  an  elevated  situation, 
produce  effects  as  good  as,  or  better  than,  can  be  obtained  from  medicinal 
doses  administered  in  the  ordinary  manner.  If  0.5  gr.  be  taken  as  an 
average  proportion  in  16  oz.,  then  only  this  amount,  representing  but 
0.14  gr.  of  metallic  iron,  is  taken  with  each  pint;  but  when  once  the  con- 
dition has  begun  to  improve,  the  iron  contained  injfooc^is  better  assimi- 
lated, so  that  improvement  is  continued  by  natural  processes.  A  few 
cubic  inches  of  carbonic  acid  suffice  to  keep  the  iron  salt  in  solution  (Fre- 
senius),  but  on  exposure  to  air  part  of  the  acid  escapes,  oxygen  is  ab- 
sorbed, and  hydrated  ferric  oxide  is  deposited.  A  chalybeate  water  will 
keep  for  some  time  if  not  shaken,  and  it  may  be  heated  up  to  87°  F. 
without  much  deposit  of  iron.  A  few  waters  contain  sulphate  or  per- 
chloride. 

Of  alkaline  waters,  Gieshtibel,  Ems,  Salzbrunn,  Bilin,  Luhatschowitz, 
Apollinaris — of  alkaline  saline  springs,  Carlsbad,  Marienbad,  Tarasp, 
Franzenbad — and  of  more  markedly  saline  waters,  Kissingen,  Wiesbaden, 
Baden-Baden,  Soden,  Kreuznach,  Rehme,  Hall,  Adelheidsquelle,  and 
Harrogate,  may  all  be  mentioned  as  slightly  chalybeate,  and  at  almost  all 
the  great  Spas  there  are  some  pure  stronger  chalybeates  for  use  besides 
the  saline;  but  among  those  frequented  specially  for  the  iron  waters  we 
may  refer  to  the  following: — 

The  Kniebis  baths  in  the  Badish  Black  Forest,  twelve  hundred  to 
nineteen  hundred  feet  above  the  sea,  with  beautiful  scenery  and  quiet 
bath  life. 

JBocJclet,  near  Kissingen,  six  hundred  and  twenty  feet  above  sea-level, 
has  a  mild  climate  and  a  rich  saline  chalybeate  water. 

Driburff,  near  Paderborn,  six  hundred  and  thirty-three  feet  elevation, 
is  situated  in  a  pleasant  valley,  and  has  a  fresh  climate. 

Ifonigsicorth,  near  Marieribad,  two  thousand  feet  above  the  sea,  in  a 
sheltered  position  on  the  southern  slope  of  a  mountain,  has  a  pure  fresh 
climate  recommended  for  chronic  pneumonic  and  phthisical  tendencies. 
The  springs  contain  from  0.4  to  0.6  gr.  of  iron  bicarbonate,  5  to  6  gr.  of 
salts,  and  30  cub.  in.  carbonic  acid. 

St.  Moritz,  in  the  Upper  Engadine,  a  day's  drive  from  the  Coire  sta- 
tion, situated  in  an  Alpine  valley,  rich  in  vegetation,  and  five  thousand 
four  hundred  feet  above  the  sea,  has  become  justly  popular,  for  the  air  is 
very  refreshing  and  agreeable  even  to  delicate  subjects,  especially  to  those 
of  sluorgrish  circulation  and  unexcitable  nervous  system.  It  is  clear  and 

O  D 

dry,  and  though  dew  falls,  there  is  little  fog  or  mist.     For  a  winter  resi- 
dence it  is  also  recommended.     The  springs  contain  0.18  to  0.25  gr.  of 
iron,  with  a  little  soda  and  lime  and  much  carbonic  acid  (31  to  37  cub. 
in.),  so  that  the  baths  are  somewhat  gaseous:  temperature,  39°  to  41°  F. 
Santa  Catarina,  in  Upper  Italy,  near  Bormio,  is  even  higher  in  situa- 
VOL.  L— 12 


178  MATERIA    MEDICA   AND    THERAPEUTICS. 

tion  (five  thousand  six  hundred),  and  in  waters  and  surroundings,  and 
scenery,  much  resembles  St.  Moritz. 

Pyrmont,  in  the  principality  of  Waldeck,  situated  in  a  deep  valley 
four  hundred  feet  above  the  sea-level,  with  a  healthy,  mild  climate,  and 
extensive,  somewhat  old-fashioned  arrangements,  was  formerly  the  most 
celebrated  of  iron  Spas.  It  has  one  of  the  stronger  compound  springs, 
containing  0.57  of  the  mineral  with  lime,  magnesia,  and  free  carbonic  acid 
(29  cub.  in).  There  are  also  salt  springs  and  baths. 

Schwalbach,  a  clean,  long-stretching  town,  on  a  sloping,  sheltered 
plateau  of  the  Taunus  range  is  nine  hundred  feet  above  the  sea.  It  is 
easily  reached  from  Wiesbaden.  It  has  pure  fresh  air,  excellent  arrange- 
ments, and  strong  iron  springs,  the  Stahlbrunnen  containing  0.64  gr., 
the  Weinbrunnen  0.44  gr.,  the  Paulinenbrunnen  0.51  gr.,  with  lime, 
magnesia,  soda,  and  much  carbonic  acid  (40  to  50  cub.  in.):  temperature, 
47°  to  50°  F. 

Spa,  in  Belgium,  one  thousand  feet  above  the  sea,  beautifully  placed 
among  the  Ardennes  forests,  at  the  foot  of  a  lofty  wooded  mountain, 
which  shelters  it  on  the  north,  is  one  of  the  most  frequented  iron  springs 
on  the  Continent  at  any  time  from  May  till  September;  afterward  the 
climate  is  apt  to  be  wet  and  cold.  The  Pouhon  spring  contains  0.37  gr. 
of  iron,  with  only  3  gr.  of  salines  and  8  cub.  in.  carbonic  acid.  The  Bari- 
sart  has  more  gas  and  less  iron. 

At  Harrogate,  the  Muspratt  spring  contains  perchloride  of  iron  with 
salines — an  unusual  and  effective  combination.  The  Tewit  contains  0.135 
gr.  of  carbonate,  with  a  little  saline. 

Tunbridge  Wells,  about  thirty  miles  south  of  London,  three  hundred 
feet  above  the  sea,  with  healthy  climate  and  beautiful  environs,  has  a  pure 
but  weak  spring,  used  formerly  much  more  than  it  is  at  present.  It  con- 
tains about  ^  gr.  of  iron  oxide  in  the  pint,  but  little  carbonic  acid,  so  that 
it  is  not  sparkling.  It  might  be  taken  with  advantage  in  Apollinaris 
water. 

At  Brighton  there  is  a  spring,  now  but  little  used,  which  contains 
sulphate  of  iron  in  small  amount,  and  at  Malvern,  Bournemouth,  Sandown, 
and  many  other  health-resorts  there  are  chalybeates  more  or  less  avail- 
able. 

THERAPEUTICAL  ACTION. — With  regard  to  the  therapeutical  use  of 
iron  waters,  formerly  invoked  so  constantly  whenever  "  strengthening  " 
was  desired,  we  must  note  that  more  discrimination  is  now  exercised. 
Sea-bathing,  mountain  air,  quinine,  nux  vomica,  and  other  remedies  are 
more  used,  and  iron  is  ordered  more  exclusively  for  true  anaemia  and 
chlorosis.  Modern  medicine,  however,  recognizes  anaemia  arising  from 
fever,  pneumonia,  and  most  acute  disorders  quite  as  distinctly  as  from 
hemorrhage  (cf.  Coupland:  "  Gulstonian  Lectures,"  March,  1881).  The 
more  rapidly  it  is  produced,  and  the  more  directly  from  loss  of  blood,  or 


MINERAL    WATERS    AND    BATHS.  179 

of  component  parts  of  blood,  as  in  hemorrhage,  exudation,  or  suppura- 
tion, the  greater  the  indication  foriron  in  full  doses:  indeed,  officinal  pre- 
parations are  often  better  in  such  cases,  and  chalybeate  waters  find  their 
use  only  in  later  stages. 

Their  advantages  are  that  they  contain  a  compound  (generally  a  bi- 
carbonate) which  is  readily  digested  by  the  stomach,  since  it  is  easily 
changed  into  lactate  or  chloride;  that  this  is  well  diluted,  and  so  more 
readily  absorbed;  and  that  the  free  carbonic  acid  given  at  the  same  time 
is  a  useful  stimulant  to  the  gastro-intestinal  membrane.  On  the  other 
hand,  these  conditions,  under  certain  circumstances,  may  be  disadvanta- 
geous, and  a  full  dose  of  more  concentrated  preparations  will  give  better 
results:  for  instance,  symptoms  of  congestion  of  the  head  or  chest,  under 
a  course  of  carbonated  chalybeate,  are  referred  by  many  physicians  to  the 
carbonic  acid  rather  than  to  the  iron,  and  in  such  cases  an  ordinary  phar- 
maceutical preparation  may  agree  better  (Braun). 

Simple  (true)  chlorosis,  occurring  during  the  developmental  period, 
seems  connected  with  direct  loss  of  iron,  which  sometimes  manifests  itself 
by  an  increase  in  the  amount  passed  in  the  urine  (Braun);  and  it  is  in  this 
form  of  anaemia  that  the  administration  of  iron  proves  most  successful. 
It  is  seen  among  the  poorer  or  the  middle  classes  more  frequently  than 
among  the  higher,  in  whom  chlorosis  is  often  complicated  with  mental 
excitement  or  depression,  hysteria,  leucorrhoea,  etc. 

The  more  indirect  the  ansemia — when  arising,  for  instance,  from  im- 
paired general  nutrition,  with  deficiency  of  albumen  and  fibrine  rather 
than  of  blood-cells,  or  from  special  derangement  of  organs  or  nerves — the 
slower  and  the  more  uncertain  is  the  effect  of  iron;  the  anaemia  of  mal- 
nutrition is  often  better  treated  by  nourishment  and  hygiene,  while  the 
former  connected,  e.g.,  with  hysteria,  may  be  aggravated  by  iron  inter- 
nally, but  relieved  by  indifferent  baths  as  at  Schlangenbad. 

Anasmia  complicated  with  or  dependent  on  .chronic  discharges,  such 
as  from  caries  of  bones,  diarrhosa,  catarrh,  etc.,  is  a  generally  impaired 
condition  of  the  blood,  and  should  be  also  treated  dietetically,  by  meat, 
fat,  milk,  and  with  due  attention  to  hygiene.  The  anosmia  of  prolonged 
lactation,  which  is  often  accompanied  by  dyspepsia,  requires  preliminary 
medical  treatment — weaning  the  infant  being  naturally  the  first  indication. 
In  amenorrhosa  and  other  disorders  of  menstruation,  the  indication  for  iron 
is  the  degree  of  anaemia.  We  should  endeavor  to  put  the  blood  in  such 
a  condition  that  nature  can  secure  from  it  a  healthy  result. 

Sometimes  a  salt  water  (such  as  Kissingen)  and  careful  hygiene  will 
give  better  results  than  iron,  while  in  other  cases  a  compound  somewhat 
purgative  iron  spring,  as  at  Franzensbad,  will  be  more  beneficial.  Gen- 
erally speaking,  constipation  in  these  cases  requires  purgative  sulphated 
or  saline  waters,  while  if  dyspepsia  or  diarrho3a  be  present,  they  must  be 
combated  by  appropriate  treatment. 


180  MATERIA    MEDIC  A   AND   THERAPEUTICS. 

Atony  of  the  stomach  and  intestinal  canal  is  often  benefited  by  a  course 
of  iron  waters,  and  the  accompanying  carbonic  acid  becomes  also  valuable 
in  this  disorder,  which  frequently  complicates  chlorosis  and  anremia. 

Certain  neuroses  are  also  much  relieved  by  chalybeates,  but  the  main 
indication  for  their  use  is  the  presence  of  anaemia. 

Most  iron  springs  are  cold,  but  are  much  better  borne  by  chlorotic 
girls  if  warmed  by  the  addition  of  hot  water  or  whey. 


ACIDUM  ACETICUM— ACETIC  ACID,  HC,H3Oa,=60. 

Acetic  acid  occurs  in  the  Pharmacopoeia  in  three  grades  of  strength — 
(1)  The  glacial  or  concentrated  acid,  which  is  three  times  as  strong  as  (2) 
the  ordinary  acetic  acid,  which  itself  is  eight  times  stronger  than  (3) 
the  dilute  acid.  Vinegar  is  an  impure  form  of  the  last  mentioned. 

ACIDUM  ACETICUM  QLAC1ALE— GLACIAL  ACETIC  ACID. 

PREPARATION. — This  acid  being  volatile  may  be  liberated  from  any 
acetate  by  distilling  it  with  a  fixed  acid,  as  sulphuric,  but  its  preparation 
is  now  left  in  the  hands  of  the  manufacturers. 

CHARACTERS  AND  TESTS. — At  the  mean  temperature  of  the  air,  the 
acid  is  liquid,  but  at  34°  F.  it  crystallizes  in  colorless  prismatic  crystals, 
which  are  not  unlike  ice,  whence  the  name,  glacial.  This  form  is  retained 
up  to  a  temperature  of  48°  F.  The  liquid  acid  has  a  pungent  acetous 
odor,  and  is  remarkable  for  the  variations  in  its  specific  gravity  according 
to  its  dilution.  By  the  addition  of  water,  the  sp.  gr.  is  raised  from  1.065 
till  it  reaches  1.073  (corresponding  to  84  per  cent,  of  anhydrous  acid, 
C4H80S),  but  any  further  addition  of  water  permanently  lowers  it. 

A  CID  UM  A CET1CUM—A  CET1C  A  C1D. 

PREPARATION. — During  the  destructive  distillation  of  wood,  an  im- 
pure acid  distils  over;  carbonate  of  soda  is  added  to  the  distillate,  and 
an  acetate  of  soda  formed,  which  is  purified  and  distilled  with  sulphuric 
acid. 

CHARACTERS. — A  colorless  liquid  of  pungent  odor  and  taste:  sp.  gr. 
1.044.  It  is  volatile  and,  on  evaporation,  should  leave  no  residue.  Con- 
tains 28  per  cent,  of  anhydrous  acid. 

ACIDUM  ACETICUM  DILUTUM— DILUTE  ACETIC  ACID. 

PREPARATION. — By  adding  1  part  of  acetic  acid  to  7  of  distilled  water. 
The  sp.  gr.  is  1.006.  Contains  3.6  per  cent,  of  anhydrous  acid. 


ACETIC    ACID.  181 


A  CETUM-  VINEGAR, 

Is  an  impure  dilute  acetic  acid,  derived  from  alcohol.  In  France  it  is 
made  from  wine,  and  is  stronger  than  the  English  vinegar,  which  is  obtained 
from  a  fermenting  infusion  of  malt  exposed  freely  to  air.  The  sugar 
it  contains  is  first  changed  into  alcohol,  which  by  further  oxidation  (under 
the  influence  of  a  fungus  found  in  the  solution)  is  transformed  into  acetic 
acid;  thus — 

C3H6O+O,  becomes  C,H4O2+HaO, 

the  acid  being  derived  from  the  alcohol  by  the  substitution  of  one  atom 
of  oxygen  for  two  of  hydrogen. 

CHARACTERS  AND  TESTS. — Vinegar  has  a  sp.  gr.  of  1.017  to  1.019,  is 
usually  brown  in  color,  and  has  a  distinctive  odor,  due  probably  to  a 
minute  quantity  of  acetic  ether:  it  contains  4.6  per  cent,  of  anhydrous 
acetic  acid.  It  is  liable  to  become  mouldy  if  exposed  long  to  the  air,  and 
in  order  to  prevent  this,  a  little  sulphuric  acid  is  commonly  added:  ygVzr 
part  by  weight  is  allowed  by  law. 

ABSORPTION  AND  ELIMINATION. — The  dilute  acid  is  readily  absorbed 
by  the  stomach,  and  combines  in  the  blood,  to  some  extent,  if  not  wholly, 
•with  soda  salts  to  form  acetate  of  soda;  like  other  salts  of  vegetable  acids 
this  is  ultimately  eliminated  in  the  urine  as  a  carbonate.  The  acetate  of 
soda  was  one  of  the  first  salts  with  which  the  decomposition  was  verified 
by  Wohler  (1824). 

PHYSIOLOGICAL  ACTION  (EXTERNAL). — Glacial  acetic  acid  is  a  caustic, 
and,  applied  to  the  ordinary  skin,  causes  redness,  pain,  and  sometimes 
vesication  or  even  inflammation  of  the  cutis  and  subjacent  tissue.  The 
diluted  acids  exert  a  moderately  irritant,  or  simply  a  cooling  astringent 
effect,  according  to  the  degree  of  dilution,  of  continuance  of  application, 
friction,  etc.  Mucous  membranes  are  blanched  by  it. 

PHYSIOLOGICAL  ACTION  (INTERNAL). — Digestive  System,  etc. — Dilute 
acetic  acid  in  moderate  doses  has  a  cooling  eupeptic  action.  It  dimin- 
ishes thirst  partly  by  causing  a  flow  of  alkaline  saliva.  In  large  quantity 
it  lessens  secretion  of  acid  gastric  juice,  and  so  stops  digestion  and  im- 
pairs nutrition. 

The  stronger  acid,  taken  into  the  stomach,  acts  as  an  irritant  poison, 
and  has  occasionally  caused  death;  it  induces  burning  sensations  in  the 
throat  and  stomach,  and  acute  abdominal  pain  with  tympanitic  distension, 
tightness  across  the  chest,  and  much  anguish;  the  buccal  mucous  mem- 
brane is  whitened,  the  tongue  becomes  dry,  cold,  and  tremulous,  nausea, 
and  vomiting  occur,  with  hurried,  labored  breathing,  and  quick,  small 
pulse;  the  pupils  are  dilated;  cold  clammy  perspirations  cover  the  body; 
nervous  tremor  and  sometimes  convulsions  have  occurred. 

Action  on  the  Blood. — This  is  very  similar  to  that  of  sulphuric  acid. 


182  MATEEIA    MEDICA    AND    THERAPEUTICS. 

Heine  (Virchow's  Archiv,  xli.,  1867,  p.  24)  examined  the  effects  of  acetic 
acid  brought  into  direct  contact  with  the  blood  by  injection,  and  came  to 
the  conclusion  that  the  acid  decomposes  the  haemoglobin,  expels  oxygen 
from  the  corpuscles,  coagulates  their  albuminous  substance,  together 
with  the  hsematin,  causes  the  passage  of  this  latter  into  the  serum,  giving 
rise  to  the  lac-color  of  the  blood.  The  red  corpuscles  become  finely  dot- 
ted in  the  centre,  owing  to  the  coagulation  of  the  albumen.  The  blood 
remains  fluid  after  only  small  doses,  but  is  always  coagulated  by  very 
large  ones.  After  direct  injection  of  the  acid  into  the  blood  the  temper- 
ature falls  2°  C.,  though  later  on,  when  the  destroyed  corpuscles  seem  to 
act  like  a  poisonous  ferment,  rigors  and  muscular  tremor  occur,  with  em- 
bolism, and  septicaemia  and  consequent  rise  in  temperature.  The  above- 
described  discoloration  of  the  blood  (lac-color)  never  takes  place  after  the 
internal  administration  of  the  acid,  as  it  does  when  injected  into  the  veins. 

SYNERGISTS. — Citric,  tartaric,  and  other  vegetable  acids. 

ANTAGONISTS — INCOMPATIBLES. — As  an  antidote  in  poisoning  by  caus 
tic  alkalies  and  lime,  vinegar  is  to  be  recommended,  since  it  is  generally 
near  at  hand,  and  the  compounds  formed  by  it  are  not  injurious.  It  is 
useful  also  in  alcoholic  intoxication.  Alkalies  and  their  carbonates  are 
chemically  incompatible  with  acetic  acid. 

THERAPEUTICAL  ACTION  (EXTERNAL). — The  glacial  acid  is  sometimes 
employed  as  a  vesicant,  and  is  used  in  the  acetum  cantharidis  as  a  solvent 
for  the  active  principle  of  the  Spanish  fly,  and  to  increase  its  efficacy. 

JVdBvi — Corns — Warts. — These  have  been  treated  successfully  with 
the  strong  acid,  and  warts  are  easily  removed  by  a  few  applications  of  it. 

Lupus. — In  the  erythematous  form  the  glacial  acid  may  be  applied 
about  twice  weekly,  with  much  advantage  and  without  production  of 
scarring. 

For  Frost-Bite,  vinegar  applied  with  friction  is  a  good  external  appli- 
cation. 

Cancer. — A  somewhat  dilute  acid  (1  part  acetic  acid  in  3  of  water) 
has  been  used  as  a  local  injection  into  cancerous  tissue,  and  Dr.  Broad- 
bent  argued  that  since  it  dissolved  cancer-cells  outside  the  body,  and 
could  readily  penetrate  living  tissues  (not  coagulating  albumen),  it  might 
lead  to  local  destruction  and  disintegration  of  malignant  growths  when 
brought  into  direct  contact  with  them:  about  30  min.  were  injected  at  a 
time,  and  some  satisfactory  results  were  reported  (Medical  Times,  1866— 
67).  I  have,  however,  seen  harm  done  by  it,  and  Heine's  experiments 
show  some  danger  in  such  injections.  This  method  of  treatment  has  not 
maintained  its  ground,  and  is  now  seldom  practised. 

Ringworm. — Acetic  acid  (1  part  in  3)  has  been  applied  in  this  dis- 
order, and  with  good  results,  but  other  remedies  are  more  commonly 
used. 

Psoriasis. — Acetic  acid  used  locally  promotes  separation  of  the  thick 


ACETIC   ACID.  183 

scales  of  psoriasis,  and  stimulates  healthy  action,  just  as  a  blister  will 
sometimes  do,  but  it  causes  much  pain  if  the  skin  is  fissured. 

Hemorrhage. — Syringing  with  vinegar  is  frequently  used  as  an  as- 
tringent and  styptic  remedy  for  bleeding  from  the  nose,  and  sponging 
with  it  for  parenchymatous  hemorrhage;  in  metrorrhagia  it  may  be  used 
by  vaginal  injection,  or  tampons  may  be  soaked  in  it.  These,  however, 
irritate  and  become  unpleasant  in  four  to  six  hours. 

Nocturnal  Sweating. — The  night-sweats  which  are  so  profuse  and  ex- 
hausting in  the  later  stages  of  phthisis  and  in  some  conditions  of  debilitv, 
are  often  controlled  by  sponging  the  body  with  warm  vinegar  night  and 
morning. 

Spermatorrhoea. — Compresses  soaked  with  vinegar  and  applied  to  the 
perineum  at  bed-time  often  cure  this  affection.  Should  soreness  be  pro- 
duced, treatment  must  be  omitted  for  a  time. 

Spinal  Weakness. — In  cases  of  aching  and  debility  referred  to  the  lower 
spine,  and  dependent  probably  on  impaired  power  of  the  erector  spinse, 
I  have  seen  much  advantage  from  sponging  the  back  with  equal  parts  of 
spirit  of  wine  and  dilute  acetic  acid. 

THERAPEUTICAL  ACTION  (INTERNAL). — Scarlet  Fever. — Dilute  acetic 
acid  is  used  by  some  practitioners  from  the  commencement  of  this  fever 
in  all  cases.  Freely  diluted,  it  certainly  makes  a  grateful  refrigerant 
drink.  Where  the  eruption  is  more  or  less  suppressed,  a  teaspoouful  of 
vinegar  given  in  sweetened  water  every  two  to  four  hours  for  a  few  doses, 
is  said  to  cause  diaphoresis,  and  to  assist  in  bringing  out  the  rash:  how- 
ever this  may  be,  sponging  the  body  with  hot  vinegar  and  water  twice  or 
thrice  daily  is  often  useful. 

Dr.  J.  Dougall  specially  recommends  the  aromatic  glacial  acetic  acid 
impregnated  with  neroli,  rosemary,  etc. — 1  dr.  to  the  oz.  of  water  is  used 
for  sponging,  and  some  is  volatilized  in  the  sick  room  (British  Medical 
Journal,  ii.,  1879). 

Diarrhoea. — When  this  occurs  in  the  course  of  phthisis,  or  hectic 
fever,  it  may  sometimes  be  controlled  by  the  internal  administration  of 
vinegar. 

Obesity. — When  vinegar  is  taken  continuously  for  five  to  six  weeks, 
it  causes  emaciation,  and  in  cases  of  obesity  was  formerly  used  with  the 
object  of  taking  down  superfluous  fat.  A  wineglassful  was  given  each 
morning,  fasting,  and  again  at  bedtime,  but  serious  consequences,  such 
as  phthisis,  etc.,  having  occasionally  followed  this  treatment,  it  has  fallen 
into  disuse. 

PREPARATIONS  AND  DOSE. — Acidum  aceticum  glaciale:  not  given  in- 
ternally. Acidum  aceticum:  used  externally  as  a  rubefacient,  vesicant, 
and  escharotic.  Acidum  aceticum  dilutum :  dose,  1  to  2  fl.  dr.,  or  more, 
well  diluted.  Oxymel:  dose,  1  to  2  fl.  dr.  Acetum  (vinegar):  dose,  1  to 
2  fl.  dr. 


184  MATERIA    MEDICA   AND    THERAPEUTICS. 

[PREPARATIONS,  U.  S.  P. — Acidum  aceticum,  sp.  gravity  1.047. 
Acidum  aceticum  dilutum:  acetic  acid  1  pint,  distilled  water  seven 
pints;  Acetum]. 

ADULTERATIONS. — Sulphuric  acid  and  metallic  impurities  taken  up 
from  metal  vessels  in  which  it  has  been  kept. 


ACIDUM  CARBONICUM— CARBONIC  ACID,  COS,=44 

(not  officirtal). 

This  gas  occurs  in  the  atmosphere  in  the  proportion  of  2  to  6  parts  in 
10,000;  the  air  contained  in  the  interstices  of  arable  land  has  more,  and 
in  some  grottoes  and  natural  hollows,  communicating  probably  with  an- 
cient volcanoes,  carbonic  acid  accumulates,  so  as  to  exert  toxic  effects. 
This  is  the  case  in  the  well-known  Grotto  del  Cane  at  Naples,  the  Upas 
valley  of  Java,  and  in  many  parts  of  Auvergne  and  Vivarais  ("  estouffis  "). 
The  gas  is  contained  also  in  all  water  in  varying  quantity,  certain  spark- 
ling waters  having  a  proportion  of  more  than  half  their  volume.  It  oc- 
curs in  all  the  liquids  of  the  organism,  principally  in  the  blood,  but  also, 
in  less  quantity,  in  the  urine:  in  the  former,  it  exists  combined  with 
alkali,  chiefly  soda,  and  also  in  a  free  state;  in  the  latter  Morin  found  a 
proportion  of  20  cub.  cent,  to  the  litre:  this  was  increased  under  adminis- 
tration of  carbonated  water,  also  after  walking  exercise:  it  was  greatly 
diminished  by  free  drinking  of  ordinary  water.  It  originates  in  the 
chemical  phenomena  of  combustion  and  nutrition  which  are  constantly 
taking  place  in  the  tissues,  and  it  readily  passes  by  osmosis  through  the 
animal  membranes. 

PREPARATION. — By  treating  any  carbonate — usually  carbonate  of 
lime — with  dilute  hydrochloric  acid:  the  resulting  gas  is  passed  into 
water  under  pressure,  and  a  solution  is  thus  obtained. 

CHARACTERS. — A  colorless  inodorous  gas  of  slightly  sharp  taste.  It 
is  soluble  in  its  own  volume  of  pure  water  at  ordinary  temperature  and 
pressure — much  more  soluble  under  increased  pressure  and  lowered  tem- 
perature of  the  water.  The  solution  gives  an  acid  reaction,  and  is 
"  sparkling"  from  rapid  escape  of  gas.  Carbonic  acid  is  much  more  solu- 
ble in  water  containing  phosphates  than  it  is  in  pure  water,  and  con- 
versely, water  containing  the  gas  can  dissolve  and  retain  in  solution, 
carbonates  and  phosphates  of  magnesia,  lime,  iron,  etc.,  which  pure  water 
cannot.  The  sp.  gr.  of  the  gas  is  1.526  (atmospheric  air  taken  as  1).  It 
is  twenty-two  times  heavier  than  hydrogen. 

ABSORPTION  AND  ELIMINATION. — Carbonic  acid  is  easily  absorbed  by 
denuded  surfaces,  and  by  mucous  and  serous  membranes.  That  it  may 


CARBONIC    ACID.  185 

be  absorbed  also  through  the  unbroken  skin  is  apparent  from  the  systemic 
effects  produced  not  only  by  carbonic  acid  baths  in  general,  but  by  keep- 
ing separate  limbs  in  an  atmosphere  of  the  gas  while  the  respiratory  or- 
gans are  protected  from  it  (Collard  de  Martigny).  If  taken  in  solution 
into  the  stomach,  it  is  said  to  be  absorbed,  if  the  viscus  be  empty — while 
if  it  be  full,  the  gas  is  rejected  by  eructation  and  per  anum  as  flatus 
(Lehmann).  Up  to  a  certain  amount,  it  may  be  absorbed  through  the 
lungs  by  the  blood.  In  any  normal  condition,  the  blood  is  never  satu- 
rated with  the  gas,  but  is  always  ready  to  receive  more  as  it  is  freshly 
formed  in  the  tissues.  It  circulates  partly  dissolved  by  the  serum  and 
partly  combined  with  alkaline  salts.  It  is  eliminated  almost  entirely  by 
the  lungs  and  the  skin,  but  in  small  proportion  by  the  kidneys;  also  by 
the  large  bowel. 

PHYSIOLOGICAL  ACTION  (EXTERNAL). — When  carbonic  acid  gas,  undi- 
luted, is  brought  into  contact  with  the  skin,  it  causes  some  prickling  and 
sense  of  warmth,  with  or  without  redness;  this  is  said  to  be  most  marked 
about  the  perineum  and  scrotum — the  latter  contracts  under  its  influence. 
To  this  effect  succeeds  a  certain  degree  of  anaesthesia  (Rotureau)  or  anal- 
gesia, which,  however,  is  not  complete  enough  for  operative  purposes 
(Demarquay).  In  contact  with  mucous  surfaces,  or  the  exposed  cutis 
vera,  the  effects  are  more  marked,  and  more  quickly  produced.  The 
oculo-nasal  membrane  is  especially  sensitive  to  a  current  of  the  gas, 
while  the  uterine  membrane,  and  even  wounded  surfaces  show  the  anaes- 
thetic effect  without  much  previous  stimulation. 

PHYSIOLOGICAL  ACTION  (INTERNAL). — Digestive  System. — When  tak- 
en into  the  stomach,  as  it  usually  is,  in  aqueous  solution,  carbonic  acid  is 
refreshing  and  thirst-quenching.  It  somewhat  increases  the  gastro- 
intestinal secretions,  and  excites  their  peristaltic  action,  but  diminishes 
the  sensibility  of  the  mucous  membrane.  A  moderate  quantity  improves 
appetite,  but  an  over-dose  lessens  it.  No  such  serious  symptoms  follow, 
however,  as  after  inhalation  of  the  gas  by  the  lungs. 

Respiratory  System. — The  gas  is  markedly  more  poisonous  when  in- 
haled than  when  taken  in  any  other  way.  It  hinders  exhalation  of  the 
carbonic  acid  normally  existing  in  the  blood,  and  is  itself  absorbed  in 
small  quantity,  thus  inducing  dyspnoea;  a  proportion  of  10  per  cent  in 
the  air  is  irrespirable  and  fatal.  The  undiluted  gas  first  excites  irritation 
and  sometimes  spasmodic  contraction  of  the  glottis  with  consequent  as- 
phyxia (Wareing);  in  any  case,  and  independently  of  such  spasm,  it  soon 
arrests  respiration.  It  has  been  thought  that  the  gas  is  itself  inert,  and 
induces  death  only  by  preventing  the  due  interchange  of  oxygen  and  car- 
bonic acid  in  the  lungs  (Bichat,  Regnault,  etc.),  but  recent  observations 
suggest  that  it  is  actively  poisonous,  since  young  mammals  die  by  cardiac 
arrest  after  two  or  three  minutes  in  an  atmosphere  charged  with  it,  while 
they  live  fifteen  to  twenty  minutes  in  nitrogen  or  hydrogen  (Paul  Bert, 


186  MATERIA   MEDICA    AND    THERAPEUTICS. 

Rabuteau),  and  the  heart  continues  to  beat  in  the  latter  case  after  respir- 
ation has  ceased.  The  experiments  of  Collard  de  Martigny,  Orfila,  van 
Hasselt,  and  others,  point  to  the  same  conclusion. 

Circulatory  System. — The  effect  of  respired  carbonic  acid  in  prevent- 
ing oxygenation  of  blood  is  quickly  shown  by  the  appearance  of  more  or 
less  cyanosis,  with  slow,  labored  pulse,  and  ultimate  arrest  of  heart-ac- 
tion. It  does  not,  however,  intimately  combine  with,  and  fix  itself  upon, 
the  haemoglobin,  since  this  remains  red  and  unreduced  in  an  atmosphere 
even  highly  charged  with  carbonic  acid,  provided  that  a  normal  amount 
of  oxygen  is  present  also;  while  in  animals  dying  deprived  of  oxygen, 
the  blood  is  found  black,  haemoglobin  being  completely  reduced.  The 
effects  of  the  internal  administration  of  the  gas,  or  even  its  careful  injec- 
tion into  the  larger  venous  trunks,  differ  from  those  produced  by  its  in- 
halation, and  are  such  as  slight  stimulation  of  the  heart-action,  quicken- 
ing of  respiration,  and  increase  of  the  peripheral  circulation,  with  a  slight 
prickling  of  skin  and  brief  sense  of  exhilaration;  this  is  often  experienced 
from  sparkling  beer,  wine,  and  even  waters.  Husemann  remarks  that 
experiments  with  "  direct  injection "  of  carbonic  acid  into  the  blood 
(Nysten,  Demarquay)  have  not  led  to  great  results,  on  account  of  the 
smallness  of  the  amount  that  can  be  injected  without  death  occurring 
from  the  entrance  of  air  into  veins.  Even  small  quantities  thus  injected 
cause  muscular  weakness,  a  symptom  which  only  appears  late  in  the  in- 
halation of  dilute  carbonic  acid  gas. 

Nervo- Muscular  System. — The  most  marked  effects  of  carbonic  acid 
poisoning  (from  breathing  the  gas)  are  exerted  upon  the  nervous  system. 
An  amount  of  3  per  1,000  in  the  atmosphere  of  a  room  will  cause  throb- 
bing headache,  with  fulness  and  tightness  across  the  temples,  and  giddi- 
ness: more  of  the  gas  may  induce  fainting,  muscular  weakness,  somno- 
lence, or  insensibility,  coma,  or  convulsion. 

Brown-Sequard  taught  that  carbonic  acid  was  a  muscular  excitant, 
because  of  the  uterine  contractions  observed  after  injecting  into  the  va- 
gina, the  excitement  induced  by  arterial  injections  of  blood  charged  with 
carbonic  acid,  and  the  convulsions  said  to  be  caused  by  directing  the  in- 
jections toward  the  head.  Cyon  further  taught  that  the  cardiac  arrest 
caused  by  this  gas  was  due  to  excitement  of  the  vagus,  but  more 
modern  observations  lead  us  to  regard  the  gas  rather  as  a  sedative.  I 
have  already  mentioned  the  local  anaesthesia  it  can  produce,  and  Leven 
always  found  in  his  experiments  anaesthesia  with  slowing  of  respiration 
and  circulation,  and  finally  cardiac  arrest — no  convulsion.  I  should  say 
with  Rabuteau  that  in  therapeutical  doses  it  modifies  sensibility,  while 
in  toxic  quantity  it  abolishes  at  once  the  functions  of  nerve  and  mus- 
cle. On  the  organs  of  special  sense,  anaesthetic  effects  are  preceded  not 
only  by  prickling  and  warmth,  but  also  by  muscae  volitantes,  tinnitus, 
and  other  phenomena  connected  with  congestion.  Herpin  found  that 


OAKBONIO    ACID. 

the  gas,  when  diluted  with  80  to  90  per  cent,  air,  produced  gradual  anajs- 
thesia  without  suffocation  or  pain. 

Nutrition — Excretion. — The  inhalation  of  carbonic  acid  modifies  the 
processes  of  nutrition  in  a  manner  not  yet  understood:  suo-ar  has  been 
found  in  the  blood  and  liver  of  animals  poisoned  by  it.  More  diuresis  is 
caused  by  carbonated,  than  by  ordinary  water.  I 

SYNERGISTS. — Alcohol,  ether,  and  other  hydro-carbons  cause  intoxica- 
tion and  produce  anaesthesia  somewhat  similar  in  character. 

ANTAGONISTS. — Oxygen  and  stimulants  of  the  peripheral  circulation. 

THERAPEUTICAL  ACTION  (EXTERNAL).  —  Wounds,  etc. — Demarquay 
and  Leconte  found  that  atonic  and  gangrenous  ulcers  and  diphtheritic 
wounds  recovered  under  applications  of  carbonic  acid  gas  when  they  had 
not  yielded  to  other  remedies.  The  cicatrization  of  wounds  was  also  fa- 
vored by  it,  and  when  injected  into  the  cellular  tissue  in  cases  of  tenot- 
omy,  repair  of  tendons  was  said  to  be  hastened  by  it,  while  by  oxygen  it 
was  retarded.  Good  results  in  the  same  class  of  cases  have  been  reported 
from  Rehme,  Nauheim,  and  other  Spas  where  the  gas  is  employed  thera- 
peutically  (v.  p.  167). 

Vesical  Catarrh,  etc. — The  pain,  the  muco-purulent  discharge,  and 
the  irritability  of  bladder  connected  with  this  malady,  may  certainly  be 
relieved  by  local  injections  of  carbonic  acid  gas — a  method  of  treatment 
not,  perhaps,  so  often  used  as  it  deserves  to  be.  Dr.  Johns,  Sir  James 
Simpson,  Dr.  Skinner,  and  others  have  reported  much  improvement  in 
many  severe  and  chronic  cases  (British  Medical  Journal,  1858;  Medical 
Times,  1858-59).  The  gas  is  disengaged  from  a  carbonate  mixed  with 
tartaric  acid,  and  conveyed  through  a  catheter,  the  bladder  being  pre- 
viously washed  out  if  possible.  It  is  desirable  to  avoid  over-distension 
of  the  viscus,  either  by  using  only  a  measured  quantity  (Skinner),  or  em- 
ploying a  double  catheter  (Johns).  If  too  much  be  injected,  there  may 
be  some  burning  pain,  and  afterward  drowsiness  and  sense  of  exhaustion, 
but  these  symptoms  are  temporary,  and  are,  in  most  cases,  not  felt  at  all, 
while  relief  follows  very  quickly  and  lasts  for  a  long  time,  suggesting 
that  the  gas  is  retained  in  the  bladder  for  several  hours  before  being  ab- 
sorbed: its  use  is  commonly  though  not  always  followed  by  excretion  of 
urine  containing  much  mucus  and  oxalates. 

The  gas  may  be  employed  in  almost  all  forms  of  irritability  of  the 
bladder,  unless  acute  inflammation  be  present — if  irritation  be  severe,  it 
may  be  diluted  with  air. 

Gout — Paralysis. — At  Kissingen,  baths  containing  carbonic  acid  gas 
are  much  used  for  these  maladies.  Dr.  Parkin  wrote  strongly  upon  the 
value  of  carbonic  acid  in  gout,  but  administered  it  in  the  complex  form 
of  a  strong  alkaline  effervescent  draught  (Lancet,  1843). 

Pelvic  and  Uterine  Pain. — In  many  painful  affections  of  the  pelvic 
viscera,  whether  neuralgic,  sympathetic,  or  even  arising  from  organic  dis- 


188  MATERIA    MEDIC  A    AND    THERAPEUTICS. 

ease,  injection  of  carbonic  acid  into  the  vagina  acts  as  an  anaesthetic  and 
sedative;  but  as  it  sometimes  increases  irritation  for  a  time,  it  is  not  suited 
for  cases  with  acute  congestion.  Dewees,  de  Rossi  (1834-35),  and  other 
physicians  of  still  earlier  date,  used  the  gas  with  advantage,  and  Sir  James 
Simpson  records  ample  and  favorable  experience  with  it  in  dysmenorrhcea, 
etc.  It  gives  relief  even  to  the  pain  of  cancer,  but  seems  to  have  sometimes 
caused  giddiness,  headache,  and  weakness  (Bernard:  Medical  Times,  i., 
1858,  p.  380).  The  warm  baths  at  Driburg  (Westphalia),  which  are  highly 
charged  with  carbonic  acid,  are  said  to  be  useful  in  cases  of  anaeimic  amen- 
orrhoea  and  leucorrhcea,  and  to  exert  a  favorable  influence  upon  utero-ges- 
tation,  so  that  healthier  children  are  born  after  their  use.  They  have  been 
described  as  "  champagne  baths,"  and  exert  a  stimulating  effect  upon  the 
whole  surface,  especially  upon  the  genitals;  they  also  induce  a  free  secre- 
tion of  urine.  They  relieve  partial  or  hysterical  paralysis  connected  with 
pelvic  irritation,  but  are  contra-indicated  in  acute  congestion  and  in  epi- 
lepsy. 

At  the  "  sool-sprudel  "  of  Kissingen,  especially  when  heated  or  when 
agitated  by  jet  or  wave,  so  large  an  amount  of  gas  passes  into  the  air  as 
to  cause  sometimes  giddiness,  dyspnoea,  etc.  At  Rehme  the  baths  are 
used  "  still "  with  better  result,  especially  in  certain  forms  of  paralysis 
and  spinal  irritation.  At  this  place,  also,  gas-baths  are  given,  but  Dr. 
Braun  does  not  attach  much  value  to  them  unless  in  cases  of  atonic  ulcer- 
ation,  and  in  irregular  menstruation  from  atony  of  uterus. 

Scanzoni  injected  carbonic  acid  gas  into  the  vagina  or  uterus  to  induce 
premature  labor,  and  with  successful  results  (Uritish  and  foreign  Review, 
ii.,  1856),  but  the  method  is  not  desirable  on  account  of  some  risk  of  the 
gas  entering  a  large  vein.  Dr.  Tyler  Smith  has  pointed  out  that  abortion 
occurs  whftre  pregnant  women  are  exposed  to  the  poisonous  influence  of 
the  gas,  but  this  may  be  secondary  to  the  asphyxia  produced. 

Phthisis. — Inhalations  of  carbonic  acid  are  indicated  in  certain  irrita- 
tive forms  of  pulmonary  phthisis,  as  likely  to  diminish  active  erethism  and 
slow  the  progress  of  destruction  (Withering,  Beddoes,  etc.).  The  air  of 
stables  is  said  to  be  beneficial  partly  for  this  reason. 

Pharyngitis — Granular  Angina. — Chronic  cases  of  these  maladies 
and  of  laryngitis  are  treated  at  Ems  by  inhalation  of  the  gas,  and  at 
Vichy  by  the  carbonic  acid  douche. 

Chronic  Bronchitis — Asthma. — Simpson  states  that  he  has  often  seen 
benefit  from  inhalations  containing  5  to  10  per  cent,  of  carbonic  acid  in 
these  maladies,  and  in  chronic  cough.  Such  inhalations  are  much  better 
tolerated  than  is  commonly  thought  (Skinner),  and  ^he.y  are  practised  at 
St.  Moritz,  at  Ems,  and  elsewhere,  but  Dr.  C.  T.  Williams  speaks  of  danger 
arising  from  them,  on  account  of  difficulty  in  regulating  the  dose  (Lancet 
ii.,  1873,  p.  516).  The  relief  given  in  asthmatic  attacks  by  the  fumes  of 
nitre  paper  has  been  attributed  to  the  carbonic  acid  contained  in  them, 


CITRIC    ACID.  189 

and  it  is  a  matter  of  clinical  experience  that  asthmatic  patients  frequently 
breathe  better  in  a  crowded  part  of  a  town — where  the  amount  of  this  gas 
is  greater — than  they  do  in  the  pure  air  of  the  country. 

Vomiting — Dyspepsia. — When  the  gastric  mucous  membrane  is  mor- 
bidly sensitive  and  irritable,  carbonic  acid  gas  dissolved  in  water  is  an 
excellent  sedative,  and  in  uncomplicated  cases  is  sufficient  to  relieve 
vomiting.  It  is  commonly  given  in  combination  with  an  alkali,  as  in  the 
ordinary  effervescent  mixture,  or  in  the  waters  of  Homburg,  Carlsbad, 
Vichy,  etc.,  but  water  charged  with  the  gas  only,  often  answers  exceed- 
ingly well,  and  has  sometimes  cured  intense  gastric  irritation  (chronic  in 
character  with  great  nerve-depression)  after  the  failure  of  treatment  at 
celebrated  Spas. 

There  are  other  virtues  attributed  to  carbonic  acid,  which  are  not  so 
well  ascertained.  Thus,  Dr.  Parkin  and  Dr.  Ritson  argued  that  the  free- 
dom of  many  ports  from  cholera  was  traceable  to  the  increased  amount 
of  carbonic  acid  in  the  atmosphere  of  their  coal  works  and  wharves  ! 
(Lancet,  ii.,  1848). 


ACIDUM  CITKICUM— CITEIC  ACID,  H8C6H6O,,  HaO=200. 

This  acid  occurs  in  many  plants  and  acidulous  fruits,  especially  in 
those  belonging  to  Aurantiaceae  or  orange  family,  and  is  commonly  ob- 
tained from  lemon  or  lime-juice  (cf.  vol.  i.,  p.  96). 

PREPARATION. — The  lemon-juice  is  first  boiled,  in  order  to  coagulate 
the  albuminous  substances,  and  then  saturated,  while  hot,  with  chalk,  so 
that  citrate  of  calcium  is  formed;  this  is  washed  with  hot  water  (it  would 
dissolve  in  cold),  and  then  treated  with  sulphuric  acid,  which  forms  sul- 
phate of  calcium  (to  be  removed  by  filtration),  and  the  solution  concen- 
trated at  a  moderate  temperature,  to  allow  citric  acid  to  crystallize  out. 
(1)  2H3C6H507  +  3CaCO3=Ca32CflH6O7  +  3H:,0  +  3COJ.  (2)  Ca,2C6H6OT 
+3H3S04=3CaS04+2H3C9H,A. 

Good  lemon-juice  yields  from  2£  to  10  per  cent,  of  citric  acid,  the 
quantity  varying  because  it  decreases  in  proportion  to  the  time  that  the 
lemons  are  kept,  and  it  may  quite  disappear,  separating  into  glucose,  car- 
bonic anhydride,  and  some  acetic  acid. 

CHARACTERS. — Occurs  in  colorless  crystals  of  which  the  right  rhombic 
prism  is  the  primary  form ;  they  are  permanent  in  dry,  but  become  moist 
in  a  damp  atmosphere;  sp.  gr.  1.6;  taste  strongly  acid,  and  almost  caustic, 
but  in  weak  solutions  only  agreeably  acid  and  refreshing;  very  soluble  in 
water  and  in  glycerin,  less  so  in  spirit,  and  not  at  all  in  ether.  Seventeen 
grains  of  citric  acid  (equivalent  to  about  \  oz.  lemon-juice)  saturate  13  of 
magnesian  carbonate,  15  of  the  ammoniacal,  20  of  the  soda,  25  of  the  potash 


190  MATERIA    MEDICA    AND    THERAPEUTICS. 

salt;  somewhat  less  than  these  quantities  are  commonly  used.  A  small 
proportion  of  citric  acid  prevents  some  chemical  decompositions,  e.g.,  in 
the  syrupus  ferri  iodidi. 

ABSORPTION  AND  ELIMINATION. — Citric  acid  is  readily  absorbed  by 
the  stomach  and  intestines,  and  is  excreted  in  part  by  the  kidneys  in  the 
urine  in  combination  with  bases.  The  greater  part  is  oxidized  in  the  sys- 
tem, forming  carbonic  acid  and  water.  Buchheim  and  Pietrowski  found 
none  in  the  urine  after  30  to  60-gramme  doses.  According  to  Bence 
Jones  and  Eylandt,  the  acidity  of  urine  is  increased  by  citric,  as  it  is  by 
tartaric  acid,  and  a  deposit  of  free  uric  acid  may  be  induced  by  it. 

PHYSIOLOGICAL  ACTION. — Concentrated  solutions  do  not  irritate  the 
skin,  hence  Mitscherlich  and  others  conclude  citric  to  be  less  irritant  than 
tartaric  acid,  but  abraded  surfaces  and  mucous  membranes  become  ir- 
ritated by  it;  and  although  it  is  not  known  to  have  caused  death  in  man, 
Husemann  considers  it,  from  its  effects  on  animals,  to  be  more  poisonous 
than  tartaric  acid.  Eight  to  fifteen  grammes  destroy  large  rabbits  with- 
in one  hour,  with  cramp,  opisthotonos,  dyspnoea,  weakened  heart-action, 
and  general  prostration.  Bobrik  observed  tremor  and  cramp,  difficulty 
of  breathing,  slowing  of  pulse,  and  lowering  of  temperature  (in  rabbits). 
On  dissection  the  blood  was  found  fluid,  and  the  gastro-intestinal  mucous 
membrane  inflamed  and  ecchymosed. 

SYNERGISTS. — Tartaric  and  other  vegetable  acids. 

INCOMPATIBLES. — Alkaline  carbonates,  acetates,  and  sulphurets;  tar- 
trate  of  potash. 

THERAPEUTICAL  ACTION  (EXTERNAL). — Cancer,  etc. — A  solution  of 
citric  acid — 60  to  90  gr.  in  8  oz.  of  water — will  sometimes  markedly 
relieve  the  pain  of  cancerous  ulceration.  I  have  verified  this  fact  in  can- 
cer of  the  tongue,  of  the  breast,  and  of  other  parts,  without  being  able 
to  explain  it.  It  is  not  generally  known,  but  has  been  several  times 
recorded,  e.g.,  by  Brandini,  by  Denny  (Lancet,  i.,  1866),  and  Barclay 
(British  Medical  Journal,  i.,  1866).  Chronic  cases  of  psoriasis  and  ecze- 
ma, especially  in  gouty  subjects,  are  relieved  by  the  daily  use  of  slices  of 
fresh  lemon. 

Pruritus. — A  hot  lotion  containing  citric  acid  is  often  serviceable  in 
relieving  itching. 

THERAPEUTICAL  ACTION  (INTERNAL). — Irritability  of  Stomach. — In 
cases  of  dyspepsia,  marked  especially  by  local  discomfort,  much  thirst, 
and  tendency  to  nausea  or  sickness,  effervescing  alkaline  citrates  are  often 
both  grateful  and  remedial.  Citric  acid,  or  its  compounds,  are  good  re- 
frigerants, and  allay  thirst  in  cases  of  fever. 

Rheumatism. — To  the  observations  already  made  on  this  subject 
(vol.  i.,  p.  96),  I  have  to  add  that  citric  acid  is  specially  indicated  in 
those  perhaps  exceptional  cases  of  rheumatism  when  the  urine  is  alkaline, 
either  from  some  peculiarity  in  the  attack  or  from  too  prolonged  use  of 


HYDROCHLORIC    ACID.  191 

alkali,  and  when  depression  is  a  marked  symptom.     In  such  a  condition 
occurring  together  with  bronchitis  and  valvular  disease  in  a  gouty  subject, 
I  have  seen  lemon-juice  given  with  some  alcohol  relieve  after  failure  of 
alkalies,  iodides,  etc. 

In  Scorbutic  Dysentery,  lemon-juice  was  commended  by  Sir  William 
Ferguson  (Edinburgh  Medical  Journal,  October,  1837),  and  for  ammon- 
iacal  urine  by  Dr.  Bence  Jones.  I  have  used  it  in  the  latter  condition, 
and  found  it  serviceable. 

PREPARATIONS  AND  DOSE. — Acidum  citricum:  dose,  10  to  30  gr.,  di- 
luted and  sweetened. 

ADULTERATION. — Sometimes  tartaric  or  sulphuric  acid. 


ACIDUM    HYDEOCHLOEICUM— HYDROCHLORIC    ACID, 

HC1,  =  36.5, 

Is  found  in  the  animal  kingdom,  in  the  gastric  juice  of  mammals  and 
fishes;  in  the  vegetable  kingdom  (Isatis  tinctoria);  in  the  mineral  king- 
dom combined  with  metals,  earths,  and  alkalies  (sodium  chloride,  etc.), 
and  in  the  springs  of  volcanic  regions.  The  hydrochloric  or  muriatic  acid 
of  the  Pharmacopoeia  is  a  solution  of  hydrochloric  acid  gas  in  water,  to 
the  extent  of  nearly  32  per  cent,  by  weight. 

PREPARATION. — Being  a  volatile  acid,  it  can  be  prepared  from  any 
chloride  by  distillation  with  the  less  volatile  sulphuric  acid — common  salt 
is  usually  employed,  and  hence  the  acid  has  been  termed  "  spirit  of  salt," 
and  "marine  acid."  When  salt  is  mixed  with  dilute  sulphuric  acid,  sul- 
phate of  sodium  is  formed,  and  free  hydrochloric  acid  distils  over  into  a 
receiver  containing  water,  in  which  it  is  very  soluble. 
NaCl  +  H,S04=NaHS04  +  HCl. 

CHARACTERS  AND  TESTS. — The  pure  acid  is  colorless,  but  the  com- 
mercial acid  yellowish,  owing  to  the  presence  of  some  organic  matter,  as 
cork,  or  of  ferric  chloride,  from  the  iron  stills  in  which  it  is  prepared.  It 
has  a  very  sour  taste  and  a  suffocating  odor,  giving  off  white  fumes  when 
exposed  to  the  air,  from  escape  of  the  acid  gas,  and  its  union  with  the 
moisture  of  the  atmosphere.  A  rod  dipped  in  liquor  ammonise  and  held 
over  a  bottle  of  the  acid  forms  dense  white  fumes  of  sal  ammoniac;  ni- 
trate of  silver  produces  a  curdy  white  precipitate  of  chloride  of  silver, 
insoluble  in  nitric  acid,  soluble  in  ammonia,  and  becoming  dark  on  ex- 
posure to  light.  The  sp.  gr.  of  the  acid  varies  with  its  strength,  the 
strongest  having  a  density  of  1.21.  The  application  of  heat  should  dissi- 
pate it  without  residue,  implying  the  absence  of  lead  and  solid  impurities. 
It  may  contain  sulphurous  acid,  which  would  be  detected  by  action  on 
lead-paper. 


192  MATEllIA   MEDIC  A   AND    THERAPEUTICS. 

ABSORPTION  AND  ELIMINATION. — The  mineral  acids  in  moderately 
strong-  solution  may  be  absorbed  through  the  skin,  as  proved,  for  instance, 
by  the  physiological  effects  produced  by  the  nitro-muriatic  bath.  Dilute 
hydrochloric  acid,  taken  internally,  is  absorbed  by  the  stomach,  probably 
unchanged,  but  any  that  passes  into  the  intestines  would  have  time  to 
combine  in  part  with  soda,  and  form  chloride  of  sodium  before  entering 
the  capillaries.  It  has  been  said  that  any  acid  introduced  as  such  into 
the  blood  becomes  so  closely  combined  with  the  albumen  as  to  reach  the 
emunctories  before  being  wholly  combined  with  alkali,  but  if  so,  the  acid  is 
not  traceable  by  test  paper  (F.  Walter:  "  Die  Wirkung  der  Saiiren,  etc.," 
Archiv.  fur  Exper.  PathoL,  April,  1877).  According  to  this  careful  ob- 
server an  acid  reaction  of  the  blood  is  incompatible  with  life.  Elimina- 
tion is  effected  mainly  by  the  urine,  the  quantity  and  the  acidity  of  this 
excretion  being  usually  increased. 

PHYSIOLOGICAL  ACTION  (EXTERNAL). — Strong  hydrochloric,  like  other 
mineral  acids,  acts  with  energy  on  animal  tissue,  abstracting  water,  and 
combining  with  potash,  soda,  and  lime  bases:  it  does  not  penetrate  so 
deeply  as  sulphuric  or  nitric  acid,  but  produces  a  white  stain,  and  this  part 
afterward  sloughs.  On  the  digestive  tract,  strong  doses  have  a  similar 
action,  and  excite  gastro-enteritis.  Fermentation  of  any  kind  is  arrested 
by  this  acid.  Dr.  John  Dougall  considers  it,  when  diluted  with  twenty 
parts  of  water,  "  the  cheapest,  most  easily  used,  and  most  effective  non- 
aerial  disinfectant,"  especially  for  typhoid  excreta  and  the  bed  and  body- 
clothes  of  persons  with  infectious  disease  (British  Medical  Journal,  ii., 
1879). 

PHYSIOLOGICAL  ACTION  (INTERNAL). — Digestive  System. — Adminis- 
tered in  moderate  dose  and  dilute  solution,  hydrochloric  acid  has  two 
main  effects — (1),  it  augments  the  acidity  of  the  gastric  juice,  and  (2), 
after  absorption,  it  gives  rise  to  extra-formation  of  chloride  of  sodium. 
It  is  first  eupeptic,  and  then  assists  hsematosis;  it  also  aids  the  solution 
of  useful  substances  which  would  be  otherwise  inert,  such  as  phosphate 
and  carbonate  of  lime,  metallic  iron,  oxides,  etc.  (Rabuteau). 

The  augmented  acidity  of  the  gastric  juice,  as  a  rule  and  within  cer- 
tain limits,  improves  the  digestive  power  and  increases  formation  of  pep- 
tones; it  is  accompanied  by  greater  secretion  of  saliva,  and  a  sense  of 
warmth  at  the  stomach,  but  if  carried  to  excess  causes  irritation.  A  great 
part  of  the  interest  connected  with  the  study  of  this  acid  depends  upon 
the  question  whether  it  really  forms  an  integral  part  of  the  normal  secre- 
tion of  the  gastric  glands,  and  there  is  certainly  a  large  amount  of  evi- 
dence in  the  affirmative.  Besides  the  older  observations  of  Prout  ("  Phil- 
osophical Transactions,"  1824),  of  Lassaigne  (Journal  de  Chimie,  t.  x.), 
and  others,  we  have  the  more  recent  analyses  of  Schmidt  ("  Die  Verdau- 
ungssafte,"  1852),  and  of  Gautier  ("  Chimie  Appliquee,"  1874),  who  even 
calculate  the  proportion  of  free  hydrochloric  acid  as  3.05  per  1,000.  It 


HYDROCHLORIC    ACID.  193 

is  not  denied  that  lactic,  acetic,  and  butyric  acids  may  also  be  found  in 
the  gastric  juice,  as  described  by  Cl.  Bernard,  Lehmann,  and  other  emi- 
nent authorities,  but  it  is  almost  certain  that  they  result  from  chemical 
changes  during  the  digestion  of  foreign  substances.  Enderlin,  examin- 
ing the  quite  fresh  gastric  secretion  of  an  executed  criminal,  could  find 
no  trace  of  lactic  acid,  nor  could  any  organic  acid  act  on  fluoride  of  cal- 
cium as  gastric  juice  does  (Melsens).  Further,  Eabuteau  claims  to  have 
demonstrated  by  an  original  process  the  existence  of  hydrochloric  acid  in 
the  secretion  of  fishes  (Comptes  Rendus,  1873)  and  of  dogs  ("Elements 
de  Therapeutiques,  1875,  p.  429).  After  a  fast  of  twenty-four  hours  he 
gave  to  two  animals  some  bits  of  tendon,  and  about  an  hour  afterward 
divided  their  medulla.  The  very  acid  gastric  juice  was  collected,  filtered, 
saturated  with  pure  quinine,  evaporated,  and  divided  into  two  portions. 
One  part  was  exhausted  by  benzine,  which  can  dissolve  hydrochlorate  and 
lactate  of  quinine  (though  not  alkaline  chlorides),  and  on  evaporating  the- 
benzine,  hydrochlorate  of  quinine  was  easily  recognized.  The  other  part 
was  treated  by  amylic  alcohol,  which  was  then  evaporated,  and  the  residue 
treated  by  chloroform,  which  took  up  a  salt  proved  to  be  solely  hydrochlor- 
ate of  quinine  without  trace  of  lactate.  He  estimated  the  quantity  of 
free  acid  at  2.5  per  1,000 — not  very  different  from  the  results  of  Schmidt, 
and  we  may  fairly  presume  that  the  acid  is  derived  from  the  chloride  of 
sodium  circulating  in  the  blood.  Lactate  of  soda  is  not  likely  to  circulate, 
inasmuch  as  it  would,  very  soon  after  absorption,  be  changed  into  bicar- 
bonate. "  A  free  acid  always  exists  in  gastric  juice,  which  is  usually  hy- 
drochloric, rarely  lactic  acid  alone,  not  unfrequently  a  mixture  of  both 
acids  "  (McKendrick's  "  Physiology,"  1878). 

If,  then,  hydrochloric  acid  be  the  normal  acid  of  the  gastric  juice,  it 
would  seem  to  be  the  one  most  easily  assimilated  by  the  stomach,  and 
should  be  preferred,  as  a  rule,  when  acid  is  indicated.  It  is  scarcely 
necessary  to  state  that  if  administered  undiluted  this  acid  causes  irritant 
poisoning  with  symptoms  similar  to  those  described  fully  under  sulphuric 
acid. 

Circulatory  System. — As  the  blood  and  lymph,  and  almost  all  the  sec- 
retions of  the  body  have  an  alkaline  reaction,  it  becomes  interesting  and 
important  to  inquire  what  effect  is  produced  upon  such  alkalinity  by  the 
administration  of  acids.  Some  observers,  as  Eylandt,  Wilde,  and  Gaeth- 
gens  have  concluded  that  any  altered  relation  of  acids  and  bases  within 
the  body  occurs,  if  at  all,  within  very  narrow  limits.1  Hoffmann  held 
that  an  excess  of  free  acid  can  pass  through  the  blood  to  the  urine,  but 
this  is  probably  incorrect.  Miguel,  after  giving  sulphuric  acid,  found  the 
alkaline  salts  of  the  urine  increased  in  amou-nt — implying  that  the  acid 

1  Souligoux  attaches  much  importance  to  it,  as  altering  galvanic  reactions  within 
the  system. 

VOL.  L— 13 


194  MATERIA   MEDICA    AND    THERAPEUTICS. 

combined  with  alkali  in  the  blood,  and  thus  removed  from  that  fluid  for 
excretion  an  unusual  proportion  of  such  alkali.  Salkowski  arrived  at  a 
similar  conclusion,  and  Lassar  asserted,  from  analyses  of  blood,  that  its 
alkalinity  was  much  lowered  under  the  use  of  acids.  But  the  estimation 
of  urinary  ingredients  does  not  give  a  satisfactory  answer  to  the  question, 
and  alkalimetry,  as  applied  to  the  blood,  is  exceedingly  difficult,  hence 
another  and  an  ingenidus  method  of  analysis  has  been  adopted  by  F. 
Walter  (op.  cit.,  April,  1875).  Starting  from  the  highly  probable  sup- 
position that  the  carbonic  acid  contained  in  the  blood  must  be  almost 
wholly  in  combination  with  alkalies,  and  that  its  amount  must  therefore 
be  proportional  to,  and  be  an  index  of,  the  amount  of  alkali  contained  in 
that  liquid,  he  analyzed  the  gas-contents  of  blood  withdrawn  from  ani- 
mals under  acid-treatment,  as  compared  with  that  of  animals  in  a  normal 
condition.  Most  of  his  experiments  were  made  with  hydrochloric  acid, 
because  it  required  less  water  for  dilution  than  other  acids.  From  1  to  3 
grammes  of  acid  were  given  diluted,  in  three  doses,  by  the  stomach  tube, 
in  the  course  of  twenty  to  forty  hours.  The  blood  was  drawn  from  veins 
after  decided  symptoms  of  acid-poisoning  had  set  in,  and  when  compared 
with  normal  blood  it  showed  a  remarkable  lessening  of  the  carbonic  acid, 
and  (by  inference)  of  combined  alkalies.  This  was  especially  the  case  in 
rabbits  (herbivora).  While  normal  rabbit-blood  showed  an  average  per- 
centage of  25  volumes  COS,  that  drawn  after  1*22  grammes  of  acid  gave 
16,  and  after  2*44  grammes  of  acid,  only  3  volumes  of  the  gas;  this  blood 
was  dark,  and  coagulated  with  difficulty,  but  was  decidedly,  though 
weakly,  alkaline  in  reaction.  In  dogs  (carnivora)  the  difference  was,not 
so  great,  but  a  diminution  of  about  10  per  cent,  in  the  amount  of  CO, 
occurred  under  the  influence  of  hydrochloric  acid.  This  curious  difference 
between  the  effects  of  the  acid  on  the  two  classes  of  animals  was  first 
pointed  out  by  Salkowski,  and  it  was  found  that  dogs  have  a  certain  im- 
munity as  to  the  general  symptoms  t>f  acid-poisoning,  so  that  they  can 
take  much  larger  doses  than  the  herbivora  without  ill  results.  (This  has 
been  accounted  for  by  the  increased  formation  of  ammonia  compounds 
in  the  latter  class  of  animals  under  the  influence  of  the  acid,  causing  its 
neutralization,  to  some  extent).  The  experiments  of  Walter  prove,  how- 
ever, that  it  is  possible,  by  means  of  the  internal  administration  of  acids, 
to  withdraw  alkalies  from  the  vital  fluids,  and  this  to  such  an  extent  as 
even  to  cause  death  from  their  deprivation. 

With  regard  to  the  influence  of  hydrochloric  acid  on  the  general  cir- 
culation, it  was  noticed  by  early  observers — Boerhaave  and  others — that 
even  moderate  doses  accelerate  the  pulse  and  cause  flushing  of  the  face; 
and  full  doses  produce  some  excitement  of  brain-function,  so  that  the 
symptoms  have  been  compared  to  those  caused  by  alcohol  (Deutsch). 
Bobrick  took  18  min.  diluted  with  5  oz.  of  water,  and  within  half  an  hour 
noted  an  increase  of  pulse  by  six  beats.  This  continued  for  an  hour,  but 


HYDROCHLORIC    ACID.  195 

was  succeeded  by  a  fall  of  four  beats  below  the  normal  frequency.  He 
noticed  excitement  of  similar  character  after  internal  and  external  ap- 
plications of  the  acid  to  frogs,  and  concluded  that  it  was  produced 
through  the  nervous  system,  for  it  did  not  appear  after  destruction  of  th< 
nerve-centres. 

Respiratory  System — Toxic  Action. — F.  Walter  found  that  in  differ- 
ent animals  of  the  same  species,  the  action  of  the  acid  was  different;  from 
7  to  8  grammes  of  hydrochloric  acid  per  kilogramme  of  body- weight  might 
be  given  to  a  rabbit  in  one  day  without  necessarily  serious  result,  but  if 
the  proportion  of  9  grammes  in  the  same  period  were  exceeded,  death 
certainly  followed  within  a  few  hours.  The  first  symptom  of  poisoning 
was  an  increase  of  frequency  in  respiration;  then  the  separate  breath- 
movements  became  deeper  and  more  laborious,  with  violent  heaving  of 
the  thorax;  the  heart  beat  so  quickly  that  the  pulse  could  not  be  counted; 
the  animal  lost  power  of  moving,  and  lay  quiet  on  the  side  for  a  quarter 
of  an  hour  before  death.  The  respiration  then  lost  its  dyspnceal  character, 
and  grew  superficial  and  weaker  as  collapse  set  in,  and  the  heart-action 
ceased  a  few  moments  after  the  breathing  (loc.  cit.  p.  157).  Post-mortem 
inspection  revealed  no  sufficient  change  in  the  organism  to  account  for  these 
symptoms;  sometimes,  it  is  true,  erosion  of  the  gastric  membrane  occurred, 
but  the  course  of  the  poisoning  was  not  altered  in  such  cases,  and  there- 
fore it  could  not  be  dependent  on  such  erosion:  a  different  concentration 
of  solution,  whether  4  or  8  per  cent.,  made  no  difference  in  the  symptoms; 
the  blood  was  only  so  far  altered  that  it  coagulated  more  slowly  than 
us4ual.  It  was  not  found  acid  in  reaction.  Hence  apparently  neutraliza- 
tion of  alkali,  or  withdrawal  of  some  portion  of  alkali  from  the  blood  and 
tissues,  was  the  cause  of  death;  and  this  hypothesis  was  remarkably  con- 
firmed by  the  results  of  injection  of  an  alkali  into  the  blood-current  after 
full  and  toxic  doses  of  acid  had  been  given  by  the  stomach.  A  rabbit  that 
had  received  more  than  6  grammes  of  hydrochloric  acid  in  three  days — 
three  times  as  much  as  would  kill  it — together  with  0'2  gramme  carbonate 
of  soda  injected  under  the  skin  with  each  dose,  recovered  without  loss  of 
appetite  or  any  symptom  of  poisoning.  Another  animal  received  more 
than  2  grammes  of  acid,  and  just  when  the  symptoms  indicated  the  near 
approach  of  death  0'5  gramme  of  soda  carbonate  was  injected  into  the 
jugular  vein;  within  ten  minutes  the  strong  thoracic  movements  subsided, 
the  heart-action  grew  slower  and  stronger,  the  animal  sat  up  and  began 
to  eat,  and  in  an  hour's  time  seemed  quite  restored.  This  direct  antidotal 
action  of  injected  alkali  is  very  striking. 

It  would  seem  that  the  result  of  diminished  alkali  in  the  blood  is  first 
a  stimulation  and  then  a  palsy  of  the  respiratory  centre,  through  which 
death  may  be  induced.  The  dyspnoea  is  not  connected  with  altered  heart- 
action,  and  the  paralysis  of  respiration  must  be  distinguished  from  that  of 
asphyxia,  for  the  oxygen  contained  in  the  blood  remains  unchanged. 


196  MATERIA    MEDIC  A    AND    THERAPEUTICS. 

SYNERGISTS. — As  refrigerant,  tonic,  and  astringent,  the  other  acids; 
as  tonic  and  digestive,  bitters,  and  also  pepsine  and  possibly  pancreatine. 

INCOMPATIBLES. — Alkalies  and  bases,  salts  of  silver  especially.  To 
neutralize  irritant  poisonous  doses  of  acid,  the  alkali  should  be  given  in 
mucilaginous  or  albuminous  liquids. 

THERAPEUTICAL  ACTION  (EXTERNAL). — Stomatitis,  etc. — In  inflam- 
mation, with  patches  of  ulceratiori  about  the  mucous  membrane  of  the 
mouth  and  gums,  hydrochloric  acid,  diluted  with  an  equal  part  of  glycer- 
in, and  applied  to  the  sloughing  spots  will  induce  healthy  action.  In 
mercurial  stomatitis,  and  in  the  aphthous  conditions  that  occur  in  chil- 
dren, or  during  advanced  disease,  lotions  containing  1  part  of  acid  in  10 
of  rose-water,  either  alone  or  with  chlorate  of  potash  and  glycerin,  are 
very  serviceable.  The  acid  is  also  valuable  given  internally  in  such  cases. 
To  avoid  possible  injury  to  the  teeth,  plain  or  alkalized  water  should  be 
used  immediately  afterward. 

Cynanche  Maligna  Ulcerosa. — In  all  forms  of  ulcerative  sore  throat, 
whether  scarlatinal  or  otherwise,  but  especially  when  sloughing  is  pres- 
ent, and  when  there  is  marked  general  asthenia,  hydrochloric  acid  is  indi- 
cated as  well  locally  as  internally.  It  may  be  applied  with  a  brush  (1 
part  in  15  of  liquid)  or  in  gargle  (2  dr.  to  8  oz.).  In  gangrenous  or  "pu- 
trid "  sore  throat,  the  nearly  pure  acid  may  be  carefully  and  lightly  pen- 
cilled over  the  affected  part. 

Diphtheria. — Bretonneau  recommended  the  application  of  the  strong 
acid  mixed  only  with  a  little  honey  to  the  false  membranes  and  adjacent 
tissues,  and  this  has  sometimes  arrested  the  local  progress  of  the  malady; 
but,  on  the  other  hand,  it  has  sometimes  done  harm  by  exciting  irrita- 
tion, which  has  favored  the  development  of  membrane.  A  weaker  solu- 
tion, such  as  the  dilute  acid  of  the  Pharmacopoeia  (1  in  3£),  is  to  be  pre- 
ferred, and  much  advantage  has  been  traced  to  it  (Dr.  Heslop:  Medical 
Times,  i.,  1858,  p.  612).  A  weaker  gargle  (1  or  2  dr.  in  8  oz.),  as  above 
mentioned,  may  be  used  if  the  conditions  admit. 

THERAPEUTICAL  ACTION  (INTERNAL). — Dyspepsia. — There  are  two 
varieties  of  indigestion  in  which  hydrochloric  acid  is  especially  indicated 
— the  so-called  "  atonic  "  form,  and  the  "  acid  "  form — but  the  mode  of 
its  use  is  somewhat  different  for  each. 

Atonic  dyspepsia  occurs  either  in  connection  with  general  weakness 
or  impaired  hygienic  conditions — for  instance,  in  over-worked  factory  girls, 
seamstresses,  etc.,— or  in  well-fed  person  who  tax  their  stomach  with  too 
much  nitrogenous  food  while  leading  a  sedentary  life.  The  secretion  of 
gastric  juice  is  but  scanty,  and  the  patient  suffers  from  weight  and  heavi- 
ness after  food,  from  general  oppression,  and  other  signs  of  unfinished 
digestion.  One  indication  for  the  treatment  of  such  a  condition  is  to 
supply  additional  acid  to  the  gastric  secretion;  but,  as  we  have  reason  to 
believe  that  adding  such  acid  before  a  meal  will  check  the  formation  of 


HYDROCHLORIC   ACID.  197 

the  naturally  acid  though  scanty  gastric  juice,  it  is  better  to  allow  this  to 
do  what  it  can,  and  to  prescribe  our  medicinal  acid  shortly  after  food  has 
been  taken,  with  the  object  of  assisting  nature,  and  not  interfering  un- 
duly.1 

In  cases  of  "  acid  "  dyspepsia,  the  patient  suffers  rather  from  heart- 
burn and  regurgitation  of  sour  fluid,  connected  either  with  hyper-secre- 
tion from  the  gastric  glands,  or  abnormal  fermentation  of  starchy,  sac- 
charine, or  fatty  food.  It  is  true  that  the  symptoms  may  often  be  relieved 
by  soda,  but  in  many  cases,  more  permanent  relief  will  be  given  bv  dilute 
hydrochloric  acid  administered  about  half  an  hour  before  a  meal.  This 
will  lessen  the  amount  of  the  natural  secretion,  and  will  check  fermenta- 
tion. 

It  is  only  recently  that  this  important  distinction  as  to  the  time  of 
taking  an  acid  with  reference  to  food  has  been  recognized;  many  writers, 
Nothnagel  for  instance,  are  satisfied  with  recommending  its  use  always 
before  meals,  and  certainly  if  it  be  given  after  food,  in  cases  of  pyrosis 
or  water-brash,  it  will  aggravate  the  mischief;  these  are  the  true  cases  in 
which  its  use  is  indicated  before  meals,  when  it  exerts  an  astringent  ac- 
tion. It  is  contra-indicated  in  acute  inflammatory,  and  also  in  organic 
disease;  and  in  any  case  its  use  should  not  be  continued  too  long,  or  the 
digestive  property  of  the  gastric  juice  will  be  impaired. 

Headache,  especially  felt  in  the  temple  and  brow,  and  marked  giddi- 
ness are  often  connected  with  the  dyspepsia  above  described,  and  are  re- 
lieved by  hydrochloric  acid. 

Diarrhoea. — In  this  complaint,  hydrochloric  is  often  preferred  to  other 
acids,  not  because  it  has  a  more  energetic  effect  than,  e.g.,  sulphuric  acid, 
but  because  it  is  better  borne  by  the  stomach.  It  is  most  reliable  in  cases 
that  are  due  to  abnormal  fermentation  in  the  bowels,  with  formation  of 
lactic  acid,  as  in  what  is  called  summer  diarrhoea  and  gastric  catarrh  of 
infants;  there  are,  however,  many  other  remedies  for  this  condition  which 
must  be  considered  better  than  the  acid. 

Fevers. — In  typhoid  or  "  low  "  fever,  hydrochloric  acid  had,  at  one 
time,  a  high  reputation;  it  was  said  to  moderate  the  pyrexia,  to  limit  the 
alteration  of  the  blood,  and  to  directly  influence  the  morbid  process.  We 
scarcely  expect  so  much  now,  but  still  there  is  reason  to  think  that  a  ju- 
dicious use  of  this  acid  may  favor  the  assimilation  of  food,  if  it  do  not  ex- 
ert antiseptic  influence.  According  to  the  investigation  of  Manassein, 
with  the  gastric  juice  of  fever  patients,  it  is  not  pepsine  that  is  deficient 
but  acid,  and  this  deficiency  may  be  supplied  for  a  time  by  the  artificial 
acid,  which  then  much  aids  the  impaired  digestion.  It  matters  little 

1  Manassein  showed  that  in  dogs  made  anaemic  by  blood-letting,  the  normal  propor- 
tion of  acid  and  pepsine  was  altered,  and  in  such  animals  an  addition  of  artificial  acid 
to  the  gastric  juice  is,  ceteris  partinu,  more  effective  than  in  the  healthy  (Virchow'a 
Archiv,  lv.,  p.  451). 


198  MATERIA   3IEDICA    AND    THERAPEUTICS. 

whether  we  say  with  this  observer,  and  with  Chambers,  that  we  supply 
deficient  acid,  or,  with  Richardson,  that  we  neutralize  by  it  super-abun- 
dant alkali  formed  during  fever.  Chambers  records  an  emphatic  opinion 
as  to  its  value,  after  a  fairly  extensive  use  of  it  at  St.  Mary's  Hospital,  in 
*•  low  "  fever,  apparently  typhus  and  typhoid.  The  treatment  by  hydro- 
chloric acid  was  more  successful  than  by  any  other  method,  but  we  must 
add  that  he  conjoined  with  the  former,  strict  attention  to  nourishment, 
giving  milk  and  beef-tea  regularly  every  two  hours,  day  and  night  (Med- 
ical Times,  1858;  Medico  Chirurgical  Review,  ii.,  1863).  Henderson 
has  reported  on  its  value  during  an  epidemic  at  Shanghai  (Medical  Times, 
i.,  1863).  On  the  other  hand,  Dr.  G.  Johnson  is  satisfied  with  the  far 
better  progress  made  by  his  typhoid  patients  in  King's  College  Hospital 
since  he  omitted  wholly  mineral  acid  from  their  treatment.  He  finds,  es- 
pecially, that  diarrhoea  is  less  troublesome,  and  considers  that  acids  irri- 
tate the  bowels,  just  as  bread  or  meat  would  do  (British  Medical  Journal, 
i.,  1875).  I  cannot  think  Dr.  Johnson's  reasoning  very  conclusive,  though 
his  facts  are  of  course  to  be  accepted.  I  think  the  acid  sometimes  useful, 
and  if  well  diluted  the  doses  required  will  not  irritate  the  bowels.  It 
may  be  given  as  a  refrigerant  drink  in  lemonade,  or  mixed  with  essence 
of  meat  so  as  to  aid  assimilation. 

Scarlet  Fever. — There  is  also  evidence  as  to  the  value  of  hydrochloric 
acid  in  scarlatina.  Osborne  records  a  prolonged  experience  in  its  favor 
(Lancet,  ii.,  1862),  and  more  recently  Egbert  (Pennsylvania)  has  quoted 
nearly  three  hundred  cases,  all  treated  by  a  mixture  containing  this  acid 
with  chlorate  of  potash  (Ranking,  i.,  1873).  He  gave  about  8  min.  of 
acid  with  20  gr.  of  chlorate  every  two  hours  to  a  child  of  six,  and  more 
or  less  than  this  according  to  age.  Occasionally  Tinct.  camph.  co.  was 
added  to  relieve  restlessness;  no  applications  were  made  to  the  throat, 
unless  sometimes  ice  externally;  only  one  death  occurred.  Of  course  it 
may  be  said  that  fevers  tend  to  get  well,  and  will  do  so  under  any  treat- 
ment, but  yet  these  results  deserve  careful  attention.  I  myself  constantly 
use  hydrochloric  acid  internally  and  locally  in  cases  of  scarlet  fever  where 
there  is  marked  general  asthenia  with  dark  ill-developed  rash,  and  ten- 
dency to  sloughing  in  the  fauces  (v.  Chlorate  of  Potash). 

Variola. — Dr.  McDonald  advocates  the  treatment  of  small-pox,  both 
internally  and  externally,  by  this  acid.  He  uses  a  lotion  containing  3  ss. 
ad  §  x.  liq.,  and  finds  it  considerably  relieve  the  cutaneous  itching  and 
irritation. 

Urinary  Deposits. — In  oxaluria,  Dr.  Prout  long  ago  recommended 
hydrochloric  acid,  and  its  use  is  especially  indicated  for  the  impaired 
digestive  power,  and  the  anxious  and  depressed  mental  condition  usually 
connected  with  the  malady  (v.  p.  197).  It  may  be  given  before  meals 
with  a  bitter,  such  as  nux  vomica  or  chirata,  and  continued  till  urates 
begin  to  appear  in  excess  in  the  renal  secretion.  In  cystic  oxide  and  phos- 


DILUTE    NITRO-IIYDROCHLORIC    ACID.  199 

phatic  deposits  with  alkaline  urine,  it  is  also  useful,  and  has  sometimes 
been  injected  into  the  bladder  for  its  local  effect  (TTtij.  ad  f  iv.  Aq.) 

Gout. — Dr.  Duncan  recommended  this  acid  as  a  preventive  of  the  un- 
due formation  of  lithic  acid  (Dublin  Quarterly  Journal,  May,  1865)  by 
its  aiding  assimilation;  hence  it  should  be  serviceable  in  chronic  gout, 
but  such  a  view  has  not  been  supported  by  the  experience  of  others,  and, 
as  a  rule,  gouty  subjects  are  very  intolerant  of  any  acid  treatment. 

There  are  several  other  disorders  in  which  hydrochloric  acid  is  some- 
times, though  not  generally  used,  but  in  which  its  good  influence  on  the 
digestive  tract  may  fairly  be  expected  to  relieve. 

Pneumonia. — Traube  states  that  he  has  found  it  useful  in  that  form 
of  pneumonia  which  sets  in  with  much  biliary  disturbance — nausea,  coated 
tongue,  gastric  catarrh,  and  diarrhoea. 

Eczema. — Mr.  Erichsen  has  published  cases  illustrating  its  value  in 
chronic  eczema  (London  Medical  Gazette,  1846,  p.  198),  but  in  this,  and 
in  hepatic  disorder,  its  value  is  better  shown  when  in  combination  with 
nitric  acid, 

Syphilis. — The  former  reputation  of  this  acid  as  a  cure  for  syphilis 
(Medical  Quarterly  Review,  1835)  in  Vienna,  need  be  mentioned  only  as 
an  historical  fact  (Nothnagel).  The  aqua  regia  may,  however,  prove  of 
service  in  chronic  cachetic  conditions. 

PREPARATIONS  AND  DOSE. — Acidum  hydrochloricum  dilutum :  dose, 
10  to  30  min.  freely  diluted.  The  strong  acid,  given  internally  in  an  un- 
diluted form,  is  an  irritant  poison. 

[PREPARATIONS,  U.  S.  P. — Acidum  muriaticum,  sp.  gr.  1.160; 
Acidum  muriaticum  dilutum :  muriatic  acid  4  troyounces,  distilled  water, 
sufficient  to  make  1  pint.] 

ADULTERATIONS. — Sulphurous  and  sulphuric  acids,  chlorine,  and  iron. 
The  commercial  acid  is  often  colored  from  the  presence  of  iron  impurities. 


ACIDUM  OTTRO-HYDROCHLORICUM  DILUTUM— DILUTE 
NITRO-HYDROCHLORIC  ACID— AQUA  REGIA. 

PREPARATION. — By  mixing  3  parts  of  nitric,  with  4  of  hydrochloric 
acid,  and  afterward  25  of  distilled  water:  the  strong  acids,  undiluted,  are 
left  to  act  upon  each  other  for  twenty-four  hours  to  insure  complete  de- 
composition and  the  full  development  of  free  chlorine. 

2HNO3  +  6HC1  =  4H,O  +  2NO  4-  3C1, 

At  the  same  time  two  other  compounds  are  formed — chloro-nitrous 
and  chloro-nitric  gas.  If  the  acids  be  diluted  before  being  mixed,  the 
same  reaction  occurs,  but  requires  several  days  for  completion. 


200  MATEBIA    MEDICA    AND    THERAPEUTICS. 

CHARACTERS  AND  TEST. — A  colorless  or  yellowish  liquid,  with  the 
odor  of  chlorine,  volatile,  and  easily  decomposed  by  light;  sp.  gr.  1.074. 
It  has  the  power  of  dissolving  gold,  the  king  of  metals — hence  its  old 
name,  "aqua  regia." 

PHYSIOLOGICAL  ACTION. — In  its  full  strength  this  acid  is  irritant  and 
corrosive;  in  moderate  doses  it  has  an  alterative  tonic  action;  it  stimu- 
lates the  glandular  system,  and  is  apt  to  cause  salivation  and  also  an  in- 
creased flow  of  bile.  Its  actual  chemical  composition  is  not  thoroughly 
known,  and  its  difference  in  action  from  the  other  and  simpler  mineral 
acids  has  not  yet  been  verified. 

THERAPEUTICAL  ACTION. — It  is  useful  in  many  of  the  diseases  men- 
tioned under  nitric  acid,  but  seems  to  possess  exceptional  power  to  influ- 
ence the  liver  and  glandular  structures  of  the  alimentary  canal. 

Hepatic  Disorder. — In  hepatitis,  not  so  much  in  the  acute  as  in  the 
chronic  form  of  the  malady,  which  usually  ends  in  enlargement  and  indu- 
ration, it  has  been  praised  by  good  authorities.  Sir  R.  Martin  strongly 
recommends  its  application  by  means  of  a  bath,  putting  about  1|-  oz.  of 
acid  to  each  gallon  of  water  (v.  Preparations).  Two  gallons  represent 
an  average  quantity  for  a  foot-bath,  which  should  be  used  warm,  and 
•while  the  feet  are  immersed,  the  inner  side  of  the  limbs  and  the  regions 
of  liver  and  spleen  should  be  sponged  alternately  for  ten  to  fifteen  min- 
utes altogether.  Martin  recommended  this  bath  morning  and  evening, 
but  I  have  usually  found  an  evening  bath  sufficient,  and  have  seen  excel- 
lent results  from  it;  generally  it  has  regulated  the  action  of  the  bowels, 
and  even  produced  laxative  effects.  Some  patients  are  nauseated  and 
weakened  by  its  use,  though  they  receive  benefit:  it  requires  watching, 
and  smaller  quantities  of  the  acid  should  be  tried  first  in  delicate  sub- 
jects. If  it  does  not  relax  the  bowels,  an  aperient  should  be  taken  occa- 
sionally during  the  course  of  the  baths. 

In  hepatic  torpor,  or  chronic  catarrhal  jaundice,  if  no  inflammation 
be  present,  and  in  chronic  dysentery  with  hepatic  congestion,  this  form 
of  bath  is  also  valuable,  and  may  be  conjoined  with  the  internal  exhibi- 
tion of  the  acid:  even  in  cirrhosis  and  the  consequent  dropsy,  benefit  has 
been  derived  from  this  treatment. 

Syphilis. — In  the  later  stages  of  syphilitic  cachexia,  when  the  blood- 
condition  is  impaired,  and  elimination  by  the  liver  and  skin  is  often  in- 
efficient, the  acid  used  internally  and  in  the  form  of  bath  has  been  recom- 
mended: a  spare  but  nutritious  diet  should  be  enjoined  in  these  cases. 

Rachitis. — Attention  has  been  drawn  by  Mr.  Brodhurst  to  the  value 
of  nitro-hydrochloric  acid  baths  in  rickets  (Lancet,  ii.,  1868);  they  should 
be  conjoined  with  hygienic,  treatment,  iron,  and  cod-liver  oil. 

Chronic  Bronchitis. — When  the  expectoration  is  profuse  and  semi- 
purulent,  sponging  of  chest  and  trunk  with  the  acid  solution  already 
mentioned  is  said  to  give  much  relief  (Dr.  Waring,  op.  cit.  p.  443). 


DILUTE    NITRO-I1YDROCHLORIC    ACID.  201 

Acne  Hosacea. — A  lotion  containing  the  dilute  acid,  1  or  2  dr.  to  8 
oz.  of  rose-water,  is  sometimes  a  useful  stimulant  to  the  affected  part, 
and  an  acid  foot-bath  tends  to  relieve  the  internal  congestions  with 
which  the  disorder  is  generally  associated. 

Oxaluria. — This  is,  in  most  cases,  dependent  on  some  fault  in  pri- 
mary digestion  (I  have  known  it  produced  apparently  by  continued  use 
of  a  drinking  water  containing  much  lirne),  besides  the  renal  symptoms, 
malaise,  depression,  and  hypochondriacal  feelings  accompany  the  malady. 
Relief  may  be  given  by  the  mineral  acids  conjoined  with  attention  to 
diet  and  drinking  water;  and  of  the  different  acids  the  nitro-hydrochloric 
seems  to  be  the  best,  as  originally  stated  by  Dr.  Prout  ("  Stomach  Dis- 
ease," p.  73);  he  advised  its  continuance  for  a  few  weeks  at  a  time,  or  until 
lithates  appeared  in  the  urine.  Deposits  of  cystine  are  relieved  by  the 
same  treatment. 

Sciatica — Rheumatism. — In  the  great  majority  of  these  cases,  an  al- 
kaline rather  than  an  acid  treatment  is  indicated,  but  when  they  occur  in 
connection  with  oxaluria  the  acid  should  be  given  (Fuller).  In  rheumatic 
gout  in  cachectic  subjects  it  is  also  serviceable. 

Dyspepsia. — In  dyspepsia  or  "  apepsia,"  connected  with  deficient  ac- 
tion of  the  intestinal  glands,  and  accompanied  with  a  chronic  looseness 
of  the  bowels,  the  acid  has  given  very  good  results,  used  in  the  manner 
directed  under  hydrochloric  acid. 

PREPARATIONS  AND  DOSE. — Acidum  nitro-hydrochloricum  dilutum  : 
dose,  5  to  20  min.,  freely  diluted  (it  is  liable  to  injure  the  teeth;  they 
should  therefore  be  cleansed  with  an  alkaline  wash  or  plain  water). 

Bath. — As  a  matter  of  convenience  the  bath  may  be  prepared  with 
six  fluid  ounces  of  the  dilute  nitro-hydrochloric  acid  added  to  each  gallon 
of  water  in  a  wooden  or  porcelain  vessel,  but  the  more  active  formula  of 
Sir  R.  Martin  is  the  following: — Acid.  nit.  fort.  3  ij.,  Acid,  hydrochloric, 
fort.  3  iij. ;  mix  and  allow  to  remain  together  for  at  least  twelve  hours; 
afterward  add  5  oz.  of  water.  Of  this  mixture  3  oz.  should  be  used  for 
each  gallon  of  water:  two  gallons  are  an  average  quantity  for  a  foot-bath. 
The  bath  may  be  kept  in  use  for  several  days  by  adding  \  oz.  of  acid  sol- 
ution and  1  pint  of  water  each  time  to  compensate  for  evaporation,  warm- 
ing only  as  much  as  is  necessary  (96°  to  98°  F.).  The  towels  and  sponges 
used  should  be  kept  in  cold  water  during  the  interval. 

[PREPARATIONS,  U.  S.  P. — Acidum  nitro-muriaticum :  nitric  acid,  3 
troyounces;  muriatic  acid  5  troyounces.  Acidum  nitro-muriaticum  dilu- 
tum: nitric  acid  1£  troyounce,  muriatic  acid  2£  troyounces;  distilled 
water,  sufficient  to  make  1  pint.] 

ADULTERATIONS. — Chiefly  sulphuric  and  hydrochloric  acids. 


202  MATERIA    MEDIOA    AND    THERAPEUTICS. 

ACIDUM  HYDROCYANICUM  DILUTUM— DILUTED  HY- 
DROCYANIC ACID,  HCN  or  HCy,=27. 

A  solution  in  water  containing  2  per  cent,  by  weight  of  the  anhydrous 
acid  (Scheele's  acid  contains  4  to  5  per  cent.,  Vauquelin's  3.3  per  cent.). 

Amygdalin  and  emulsin,  from  which  the  acid  is  developed,  exist  to- 
gether in  many  plants;  in  the  leaves  of  the  cherry-laurel,  the  kernels  of 
the  peach,  almond,  cherry,  etc.  In  the  mineral  kingdom  the  acid  is  found 
in  combination  as  cyanate  and  cyanide;  it  occurs  also  in  various  animal 
secretions,  and  may  be  obtained  by  heating  nitrogenized  organic  matter 
in  contact  with  a  base.  Scheele  discovered  the  acid  in  1782,  and  is  said 
to  have  been  accidentally  poisoned  by  it. 

PREPARATION. — By  distilling,  with  gentle  heat,  a  mixture  of  ferrocy- 
anide  of  potassium  (yellow  prussiate  of  potash)  and  dilute  sulphuric  acid. 
Half  the  cyanogen  passes  over  into  the  water  of  a  cooled  receiver  as  hy- 
drocyanic acid,  and  part  remains  in  combination  with  potassium  and  iron 
as  a  yellowish-white  insoluble  double  salt  (Everitt's  salt).  Some  acid  sul- 
phate of  potassium  is  also  formed:  thus — 2K4FeCy64-GHaSO4=FeK2Fe 
Cy,  +  6KHSO4  +  6HCy. 

CHARACTERS  AND  TESTS. — The  pharmacopceial  solution  is  a  colorless 
volatile  liquid  of  characteristic  bitter-almond  odor.  Its  taste  has  been 
variously  described  as  "  hot  and  bitter  "  (Taylor),  or  "  cooling,  afterward 
irritating"  (R.  W.  Smith);  sp.  gr.  0.997  (nearly  that  of  pure  water).  If 
free  from  other  acid  it  reddens  litmus  but  transiently.  It  loses  strength 
on  exposure  to  air  and  light,  but  that  which  is  prepared  by  the  pharma- 
copceial process  and  kept  in  dark-colored  bottles  may  be  retained  for  years 
without  perceptible  change.  Stronger  solutions  alter  more  readily,  and 
of  the  anhydrous  acid  (which  has  sp.  gr.  of  0.697)  a  part  evaporates  on 
paper  so  quickly  as  to  freeze  the  rest.  Cyanides  prevent  fermentation, 
and  are  fatal  to  vegetable  life  (Dumas). 

1.  The  White  or  Silver  Test. — Nitrate  of  silver  gives,  with  prussic 
acid  solutions,  a  dense  flocculent  white  precipitate  of  cyanide  of  silver, 
insoluble  in  cold,  soluble  in  boilirig  nitric  acid — HCy+AgNO,=AgCy 
-t-HNOs.  This  test  may  be  conveniently  applied  to  the  detection  of 
prussic  acid  vapor  by  means  of  two  watch  glasses,  the  lower  one  contain- 
ing a  little  of  the  suspected  solution,  and  the  upper  one,  inverted  over  it, 
a  few  minims  of  nitrate  solution  (1  gr.  to  the  oz.):  the  latter  soon  be- 
comes opalescent,  and  when  dry,  leaves  a  white  stain,  showing  under  the 
microscope  prisms  or  long  plates  interlaced.  Cyanide  of  silver,  like  other 
insoluble  cyanides,  may  be  further  tested  by  placing  it  in  a  narrow  glass 
tube  drawn  out  at  one  end  and  heating:  cyanogen  will  escape  and  may 
be  lighted  at  the  pointed  end;  it  burns  with  a  rose-colored  flame,  having 
a  bluish  halo. 


DILUTED    HYDROCYANIC   ACID.  203 

2.  The  Blue  or  Iron  Test.—  Tills  is  applied  by  adding  to  the  solution 
a  little  liquor  potassae  and  a  few  drops  of  a  mixed  solution  of  a  proto- 
and  per-salt  of  iron  (protosulphate  and  perchloride  are  commonly  used); 
a  greenish-brown  precipitate  falls,  which,  on  addition  of  a  little  dilute 
hydrochloric  acid,  becomes  dark  or  Prussian  blue  in  color.  The  potassic 
cyanide,  first  formed,  gives  rise  to  ferrocyanide  and  afterward  to  ferric 
cyanide  with  the  iron  salts,  thus: 
HCy+KHO  = 


4KCy  +  FeCya=K4FeCy. 


The  acid  dissolves  any  excess  of  precipitated  iron  oxides  that  might  ob- 
scure the  color. 

3.  The  Red  or  Sulphur  Test.  —  Add  to  the  solution  a  few  drops  of  am- 
monia and  of  yellow  sulphide  of  ammonium;  warm  gently  till  colorless, 
and  evaporate  slowly;  £o  the  residue  add  a  drop  of  acid  solution  of  per- 
chloride of  iron;  a  blood-red  color  (sulphocyanide  of  iron,  Fea6CyS)  is 
developed;    it    is    discharged   by   corrosive   sublimate,   and   thus   distin- 
guished from  meconic  acid.     In  this  test  some  free  sulphur  in  the  ammo- 
nium sulphide  unites  with  the  alkaline  cyanide  to  form  sulphocyanate  of 
ammonia. 

2AmCy+S3=2AmCyS. 

The  ammonia  combines  with  excess  of  free  sulphur,  and  forms,  among 
other  compounds,  sulphydrate  of  ammonium,  which  should  be  removed 
by  boiling  and  evaporation,  and  if  this  be  not  carried  far  enough,  some 
of  the  latter  compound  remains  and  gives  rise  to  black  sulphide  of  iron 
instead  of  sulphocyanide  on  addition  of  the  perchloride  solution. 

These  two  tests  are  also  applicable  to  the  vapor  by  means  of  watch 
glasses. 

4.  The    Copper   Test.  —  To  the  liquid,  rendered  slightly  alkaline  by 
liquor  potassae,  add  solution  of  sulphate  of  copper;  a  greenish-white  pre- 
cipitate falls,  containing  cyanate  of  potash  and  of  copper  with  some  blue 
oxide.     When  this  is  dissolved  by  a  little  hydrochloric  acid,  the  precipi- 
tate becomes  nearly  white. 

ABSOKPTION  AND  ELIMINATION.  —  Hydrocyanic  acid  is  absorbed  to 
some  extent,  even  through  the  unbroken  skin,  especially  if  a  strong  solu- 
tion be  applied  with  friction;  from  a  wound,  or  from  mucous  membrane, 
it  is,  however,  absorbed  much  more  readily.  When  placed  on  the  tongue 
or  swallowed  in  the  ordinary  way,  it  passes  sooner  into  the  circulation 
than  when  injected  into  the  stomach,  rectum,  or  vagina  (Coullon,  Kn- 
mer).  In  less  than  thirty-six  seconds  after  a  little  of  the  strong  acid  is 
placed  on  an  animal's  tongue,  it  may  be  detected  in  the  circulating  blood 
(Krimer:  Horn's  Archiv,  1826):  after  intravenous  injection,  also,  it 
quickly  produces  its  effects,  but  most  quickly  after  inhalation.  Guinea- 


204  MATERIA    MEDICA    AND    THERAPEUTICS. 

pigs  made  to  inhale  the  anhydrous  acid  for  one  second,  die  within  fifteen 
seconds,  and  strong  rabbits  exposed  to  the  vapor  for  three  seconds,  are 
destroyed  within  thirty  (Preyer:  "Die  Blausaure,"  zw.  Theil,  1870,  s. 
133).  The  weakly,  the  young,  and  the  aged  among  warm-blooded  ani- 
mals are  much  more  easily  affected. by  the  acid;  while  frogs,  and  all  cold- 
blooded creatures,  are  much  less  sensitive  to  its  action,  and  survive  toxic 
doses  for  several  hours.  Horses  are  said  to  be  insusceptible  to  quanti- 
ties of  one  or  two  ounces  (Amory:  Boston  Journal,  1866). 

Although  so  rapidly  poisonous  to  most  animals  as  it  is  also  to  men, 
there  is  yet  no  difficulty  in  concluding  that  absorption  must  precede  any 
general  action,  and  Stille  has  shown  that  if  a  tight  ligature  be  placed 
round  a  limb  exposed  to  the  acid,  constitutional  effects  do  not  occur,  so 
long  as  the  local  is  cut  off  from  the  general  circulation  (vol.  ii.,  p.  222,  3d 
ed.).  Ordinary  blood  is  not  essential  to  its  action,  for  the  bloodless 
"  salt  frog  "  exhibits  the  same  symptoms  under  prussic  acid  as  the  normal 
creature  (Lewisson:  Reichert's  Archiv,  1870.)  ^ 

Elimination  is  rapid,  and  for  ordinary  medicinal  doses  is  probably 
complete  within  an  hour;  even  after  a  full  or  poisonous  amount,  if  life 
can  be  prolonged  for  that  time,  recovery  may  be  hoped  for.  The  acid 
passes  out  partly  by  the  saliva,  to  a  slight  extent  by  the  kidneys,  but 
mainly  by  the  lungs,  as  evidenced  by  the  characteristic  odor  of  the 
breath. 

PHYSIOLOGICAL  ACTION  (INTERNAL). — Digestive  System. — Small  medi- 
cinal doses — 2  to  5  min.  of  the  officinal  acid — seldom  exert  more  than 
a  transient  effect  of  sedative  character  on  the  gastric  mucous  membrane; 
10  to  20  min.  induce  local  irritation  of  the  fauces  and  stomach,  with  in- 
creased flow  of  saliva  and  nausea;  breathing  the  vapor,  or  taking  by  the 
mouth  20  to  30  min.  or  more  of  the  diluted  acid,  causes  such  symptoms  in 
a  marked  degree,  though  not  always  immediately  (Taylor). 

Toxic  Action. — If,  with  animals,  such  doses  be  used  as  allow  time 
for  a  somewhat  gradual  poisoning,  vertigo  is  noted  as  an  early  symptom, 
with  loss  of  power  over  the  muscles,  so  that  the  animal  quickly  falls;  the 
breathing,  at  first  perhaps  hurried  and  panting,  soon  becomes  slow  and 
difficult,  while  the  heart-beats  are  rapid  and  weak.  Convulsions  mark 
(according  to  Preyer)  the  second  stage  of  cyanic  poisoning;  they  may  be 
tonic  or  clonic,  and  affect  not  only  the  limbs,  but  the  respiratory  muscles 
and  the  heart:  livid  features,  protruding  shining  eyeballs,  and  congested 
veins  evidence  the  obstructed  circulation,  and  either  death  soon  comes 
from  asphyxia,  or  after  a  period  of  paralysis  and  torpor,  recovery  gradu- 
ally ensues.  Evacuations  from  the  bladder  and  bowel  commonly  occur 
during  the  unconscious  stage,  and  a  peculiar  shriek  often,  though  not 
always,  precedes  death.  Post-mortem,  intense  congestion  of  the  larger 
venous  trunks  and  the  cerebral  membranes  is  the  most  marked  appear- 
ance. 


DILUTED    HYDROCYANIC    ACID.  205 

In  man,  more  than  60  min.  of  the  dilute,  or  1  gr.  of  the  anhydrous 
acid,  will  be  usually  a  fatal  dose,  though  symptoms  may  not  be  devel- 
oped for  some  minutes;  after  as  much  as  ^  fl.  oz.,  however,  they  will 
come  on  in  a  few  seconds,  or  even  during  the  act  of  swallowing  Volition 
and  power  may  be  retained  just  long  enough  to  walk  a  few  paces,  to  ar- 
range the  bed-clothes,  or  to  cork  a  phial;  but  suddenly  the  subject,  if 
standing,  will  fall  prostrate,  often  with  a  scream  or  in  convulsions. 
Within  two  minutes  he  will  be  insensible,  paralyzed,  with  fixed  and  glis- 
tening eyes,  dilated  insensible  pupils,  cold  clammy  skin,  and  swollen 
cyanotic  face:  the  jaw  is  set,  saliva  exudes  from  the  mouth,  and  evacua- 
tions occur  from  the  bladder  and  bowel:  the  breathing,  at  first  perhaps 
hurried,  soon  becomes  convulsive  and  gasping,  with  long  pauses  and  pro- 
longed expiration:  the  pulse,  after  a  brief  quickening,  is  soon  impercep- 
tible, and  death  occurs  by  asphyxia  within  three  to  five  minutes  from  the 
fatal  dose.1 

Respiratory  System. — In  man,  ordinary  medicinal  doses  do  not  affect 
respiration,  but  10  to  20  min.  may  render  it  irregular  and  labored.  Under 
small  doses,  the  breathing-rate  of  animals  either  remains  unaltered  at 
first,  or  is  markedly  lowered;  it  is  never  increased.  With  larger  doses 
and  concentrated  solutions,  the  course  of  poisoning  is  so  rapid  that 
respirations  can  scarcely  be  counted;  convulsive  movements  also  interfere 
with  observation,  but  we  can  say  that  in  this  stage  the  rate  is  lowered, 
and  continues  so.  As  the  animal  passes  into  a  comatose  condition,  a 
slight  rise  may  occur,  which  increases  if  recovery  is  proceeding,  but 
which  soon  gives  place  to  a  marked  slowing  and  then  complete  cessation 
of  breathing.  The  heart  may  continue  to  beat  for  some  little  time  after 
this,  and  if  so,  even  if  in  other  respects  the  animal  seems  dead,  artificial 
respiration  will  restore  it  to  life. 

The  general  character  of  the  respiratory  changes  resembles  (according 
to  Preyer),  not  that  occurring  in  apncea,  but  that  which  occurs  when  the 
vagi  are  divided  and  the  cut  end  of  the  central  branch  is  stimulated,  or 
irritated,  by  electricity.  At  the  beginning  of  the  poisoning  the  inspira- 
tions are  deeper  than  normal,  then  follows  a  pause,  and  then  short  shal- 
low expirations.  In  many  instances  during  the  convulsive  stage  there 
occurs  on  inspiration  a  tetanic  spasm  of  the  diaphragm,  such  as  Traube 
found  after  direct  vagus  irritation. 

Nervous  System.— Doses  which  disturb  the  digestive  and  circulatory 
systems— 10  to  20  min.— may  cause  not  only  giddiness,  but  also  a  sense 
of  constriction  and  heaviness  of  the  head,  prominence  of  the  eyes,  some 
confusion  of  intellect,  and  muscular  weakness.  Upon  which  part  of  the 

1  The  glistening  condition  of  the  eye  usually  described,  and  the  evacuation  of  the 
bladder  and  bowel,  are  not,  I  think,  so  constant  as  commonly  supposed :  in  four  cases 
within  my  experience,  the  former  symptom  was  not  present,  and  in  only  one  did  the 
evacuations  occur. 


206  MATERIA    MEDICA    AND    THERAPEUTICS. 

nervous  system  the  special  effects  of  larger  doses  are  exerted — whether 
upon  the  vagus,  the  nerve-centres,  or  the  peripheral  nerves — has  been 
disputed. 

Vagus  Nerve. — Arguing  from  the  conditions  already  described,  and 
from  the  fact  that  poisoning  by  prussic  acid  is  most  rapid  if  the  vapor  bti 
inhaled,  Preyer  concluded  that  its  chief  action  was  exerted  on  the  vagus 
terminals  in  the  lungs,  stimulation,  or  rather  irritation  of  them  being 
propagated  to  the  respiratory  centre,  and  causing  the  phenomena  of  as- 
phyxia. That  the  stimulation  was  not,  in  normal  conditions,  exerted  di- 
rectly on  the  respiratory  centre  he  held  to  be  evident  from  the  fact,  already 
noted,  that  section  of  the  vagi — i.e.,  interruption  of  communication  be- 
tween the  ends  and  the  centre — delayed  the  course  of  the  poisoning  and 
the  time  of  death:  the  occasional  occurrence  of  tetanic  spasm  of  diaphragm 
he  explained  by  a  secondary  transfer  of  irritation  from  the  medulla  to  the 
phrenic  nerve.  In  animals  with  divided  vagi,  the  respiratory  changes  were 
somewhat  different,  and  death  in  such  cases  was  explained  either  by  an 
action  on  the  terminals  of  other  (unknown)  nerves  of  the  lungs,  or  by 
direct  action  on  the  centre  in  the  medulla,  or  when  occurring  under  large 
doses,  by  direct  paralysis  of  the  heart. 

Nerve- Centres. — On  the  other  hand,  Boehm  and  Knie,  conclude  that 
the  main  change  is  always  exerted  on  the  central  nervous  system — the 
medulla — the  functions  of  which  are  for  a  brief  period  stimulated  and 
then  destroyed  (Archiv  fur  Exper.  Path.  Jflebs.,  Bd.  ii.,  p.  137).  In  cats 
prepared  for  experiment  according  to  their  method,  there  occur  under 
prussic  acid  at  first  two  to  four  deep  labored  inspirations,  then  quick  and 
convulsive  expiration,  "  resembling  that  caused  by  irritation  of  the  superior 
laryngeal  nerve  "  (Rosenthal);  they  observe  no  inspiratory  cramp  or  teta- 
nus, and  no  influence  of  the  vagi,  whether  it  be  left  entire  or  divided, 
upon  the  course  of  the  poisoning,  nor  upon  the  heart  (v.  p.  268).  (The 
practical  result  is  that  these  observers  attach  no  value  to  atropia  as  an 
antidote,  though  equally  with  Preyer  they  recognize  the  excellent  results 
to  be  obtained  by  artificial  respiration.) 

I  am  not  prepared  to  reconcile  the  differences  between  these  and  other 
observations,  but  in  a  more  recent  essay  Preyer  attributes  the  differences 
to  undue  manipulation  of  the  animals,  maintains  his  conclusions  unaltered, 
and  offers  additional  facts  in  support  of  some  of  them  (Archiv  fur  Exper. 
Path.  JEflebs.,  April,  1875).  We  must  add,  however,  that  Lecorche  and 
Meuriot,  while  agreeing  with  him  that  cyanic  death  is  connected  with 
intense  excitation  of  the  vagus  nerve,  and  that  section  of  the  vagi  delays 
it,  yet  attribute  such  excitation  to  a  central,  not  peripheral,  action  of  the 
poison.  A  striking  experiment  made  by  Prof.  Jones  bears  in  the  same 
direction:  having  found,  with  alligators,  that  the  internal  giving  of  the 
poison  did  not  easily  or  quickly  take  effect,  he  applied  it  directly  to  the 
medulla  oblongata,  and  within  sixty  seconds  there  followed  complete  ex- 


DILUTED    HYDKOCYAN10    ACID.  207 

piration  of  the  air  contained  in  the  lungs,  with  collapse  of  those  organs, 
and  tetanic  contraction  of  the  respiratory  muscles  (New  York  Medical 
Record,  vol.  ii.). 

The  convulsions  which  often  occur  in  cyanic  poisoning  are  cerebral  in 
origin,  for  they  do  not  occur  in  parts  situated  below  a  transverse  section  of 
the  spinal  cord — i.e.,  in  parts  with  which  cerebral  communication  has  been 
interrupted  (H.  C.  Wood).  We  may  further  conclude  that  they  are  con- 
nected with  disturbed  cerebral  circulation,  for  they  have  been  noticed  to 
commence  directly  after  cardiac  arrest  (Laschkewitsch,  Coze). 

Peripheral  Nerves  and  Muscles. — We  are  unable  to  conclude  positively 
with  Preyer  that  the  peripheral  ends  of  the  vagus  receive  the  first  and 
main  influence  of  the  poison,  for  the  mere  extent  of  absorbing  surface  and 
ready  contact  with  blood  in  the  lungs  would  go  far  to  account  for  the 
greater  rapidity  of  the  effects  of  inhalation,  and  there  is  other  evidence 
that  the  respiratory  centres  are  affected.  This  question,  however,  apart, 
we  may  accept  the  careful  observations  of  Kolliker,  that  peripheral  sensory 
nerves  are  paralyzed  by  local  contact  with  sufficiently  strong  solutions, 
and  the  early  disappearance  of  reflex  function  in  cyanic  poisoning  is  con- 
nected with  such  paralysis  rather  than  with  paralysis  of  the  cord  (Kied- 
rowski).  Nerve-tissue  placed  in  a  solution  of  prussic  acid  loses  its  con- 
ducting power,  and  muscular  tissue  loses  its  irritability  still  more  quickly, 
although  the  nerve-trunks  are  probably  acted  upon  at  the  same  time  as 
the  muscles  after  internal  administration  of  the  acid  (Virchow's  Archiv, 
Bd.  x.,  p.  272).  When  the  whole  blood  is  rendered  venous,  as  in  later 
stages  of  poisoning,  there  is  increased  action  of  the  contractile  fibres  of 
organic  life  (involuntary  muscular  tissue),  and  hence,  often  increased 
peristalsis  of  the  intestine,  contraction  of  the  bladder,  and  evacuations 
from  those  viscera.  The  same  result  occurs  sometimes  in  asphyxia  from 
hanging,  carbonic  acid  poisoning,  etc.,  and  is  commonly  attributed  to  the 
same  cause  (venosity  of  blood),  though  indeed  it  may  result  from  paral- 
ysis of  sphincters,  as  it  does  under  chloroform,  or  during  an  epileptic 
attack. 

Circulatory  System. — Continued  small  doses — 1  to  5  min. — given  at 
moderate  intervals  of  two  to  four  hours,  lessen  the  force  and  rapidity  of 
the  heart-action:  10  to  20  min.  taken  by  the  mouth,  or  inhaled,  may  cause 
giddiness  and  faintness,  with  slowing,  or  sometimes  quickening,  of  the 
pulse,  and  suffusion  of  the  face.  With  animals,  full  or  large  doses  cause 
a  sudden  arrest  in  diastole;  this  continues  for  a  variable  time,  and  is  fol- 
lowed by  quickened  action,  and  afterward  by  diminution,  and  then  by 
either  gradual  return  to  the  normal  number  of  beats,  or  total  cessation 
according  to  the  dose,  and  to  the  age,  strength,  etc.,  of  the  animals  (La- 
schkewitsch, Preyer). 

A  point  of  much  interest  is  the  statement  that  section  of  the  vagi  in 
the  neck  prevents  this  primary  diastolic  arrest,  and  Preyer,  who  has 


MATERIA    MEDICA    AND    THERAPEUTICS. 

studied  the  subject  with  the  greatest  care,  and  has  made  very  numerous 
experiments,  affirms  that  after  such  section,  no  slowing  of  the  heart-action 
occurs  under  doses  that  would  with  uncut  vagi  stop  the  heart  (Op.  cit., 
erst.  Theil,  1868,  p.  35);  also  that  death,  under  toxic  doses,  is  much  slower 
when  these  nerves  are  divided  than  when  they  are  not.  We  know  from 
Pfliiger's  researches  that  weak  stimulation  of  the  vagus  causes  slowing  of 
the  heart,  and  a  very  strong  stimulus  of  it  causes  stoppage  in  diastole, 
and  Preyer  argues  that  the  action  of  prussic  acid  on  the  heart  is  exerted 
through  the  vagi  in  accordance  with  these  results,  and  the  secondary  and 
temporary  quickening  which  occurs  with  certain  doses  is  due  to  a  second- 
ary paralysis  of  the  control-influence  of  the  same  nerves. 

On  the  other  hand,  we  have  directly  contradictory  observations  upon 
cats  by  Boehm  and  Knie,  who  found  no  primary  diastolic  arrest,  and  no 
influence  exerted  either  way  by  section  of  the  pneumogastrics;  but  their 
animals,  though  more  accurately  dosed,  were  in  still  less  natural  condition 
than  those  of  Preyer,  for  they  were  chloralized,  tracheotomized,  and  in- 
jected through  an  exposed  jugular  vein:  we  cannot  think  their  observa- 
tions conclusive  (v.  p.  265). 

With  very  large  toxic  doses  death  is  instantaneous,  and  the  heart  is 
arrested  in  diastole  without  any  recurrence  of  ventricular  contraction, 
though  some  movement  of  the  auricles  may  be  perceived  on  opening  the 
chest  (Lecorche  and  Meuriot,  Archives  Gen.,  t.  xi.,  6e  serie):  with  such 
doses  the  result  is  not  influenced  by  section  of  the  vagi,  and  death  is  pre- 
sumed to  follow  direct  cardiac  paralysis  (Preyer).  Applied  directly  to 
the  heart,  the  acid  arrests  its  movement  and  destroys  its  muscular  irrita- 
bility. 

Arterial  Pressure  in  the  vessels  is  said  to  be  increased  under  the  ac- 
tion of  prussic  acid  (Wahl),  but  according  to  Boehm  and  Knie,  such  in- 
crease is  temporary  only;  the  pressure  soons  falls  below  normal,  and  after 
large  doses  remains  so  for  some  time. 

The  startling  rapidity  of  action  of  prussic  acid  suggests  an  immediate 
toxic  effect  on  the  blood,  and  there  is  indeed  a  remarkable  color-change 
induced,  which  has  been  thought  to  give  a  clue  to  the  intimate  working 
of  the  poison.  Thus,  if  the  jugular  vein  of  a  rabbit  be  exposed,  and  seen 
to  contain  dark  blood,  and  a  toxic  dose  of  acid  be  then  given  by  the  mouth, 
so  soon  as  convulsive  movements  indicate  its  taking  effect,  will  the  stream 
of  venous  blood  take  on  a  clear  red  color,  and  the  vessel  greatly  enlarge 
in  size.  Tf  the  blood  be  let  flow  from  an  incision,  a  similar  change  is  ob- 
served, and  if  the  right  heart  be  examined  in  sitfl,  the  dark  blood  contained 
in  it  is  equally  seen  to  become  red ;  it  is  so  also  in  the  nose  and  ears  (Gaeth- 
gens:  Med.-Chem.  Untersuch.,  drit.  Heft.,  Berlin,  1868,  Hoppe-Seyler). 
This  had  been  noticed,  though  with  less  detail,  by  earlier  observers,  by 
Vietz  and  others,  by  Claude  Bernard  (who  got  a  similar  result  with  car- 
bonic oxide),  and  by  Preyer,  who  found  the  same  appearance  caused  not 


DILUTED    HYDROCYANIC    ACID.  209 

only  by  diluted  sulphuretted  hydrogen,  but  also  by  the  mere  removal  of 
any  obstructions  placed  in  the  air-passages  (Op.  cit.,  p.  88).  It  is  not 
therefore,  due  to  a  specific  action  of  prussic  acid,  but  is  secondary  to 
altered  respiration,  and  although  very  interesting,  has  rrot  the  importance 
•attached  to  it  by  Gaeth'gens.  The  apparently  contradictory  observations 
of  Bischoff  and  others,  to  the  effect  that  all  the  blood  found  in  the  body 
after  cyanic  poisoning  is  unusually  dark  and  venous,  are  explained  by  a 
difference  mainly  in  the  rapidity  of  the  poisonous  action:  if  life  be  pro- 
longed for  a  few  minutes,  the  red  color  is  gradually  replaced  by  dark, 
while  if  death  be  very  sudden,  red  blood  only  is  found  in  the  heart — 
sometimes  even  on  the  following  day  (C.  Bernard).  In  cold-blooded  ani- 
mals, the  red  color  persists  much  longer  than  in  the  warm-blooded  (Preyer). 

Theory  of  Action. — It  is  easier  to  ascertain,  than  it  is  at  present  to 
explain  these  facts.  Hoppe-Seyler  suggests  that  the  red  corpuscles  lose 
for  a  time  their  power  of  giving  up  oxygen  in  the  capillaries — that  oxida- 
tion of  tissue  is  suspended  (  Uhtersuchungen,  1866,  erst.  Heft,  s.  140). 
Geinitz  argued  that  a  change  in  the  physical  form  of  the  corpuscles  would 
explain  change  of  color,  and  found  that  the  acid  mixed  with  blood  outside 
the  body  caused  various  alterations  of  their  form  (Pfliiger's  Archiv,  Bd. 
iii.,  1870):  but  according  to  Preyer  the  blood  of  a  poisoned  animal  taken 
from  the  vessels  directly  after  death,  and  examined  by  the  microscope, 
exhibits  no  change  in  the  character  of  the  corpuscles  (Chemismus,  Leip- 
sic,  1840).  He  inquires  whether  the  deepened  breathing  could  for  a  time 
induce  a  hyper-oxygenated  condition,  as  in  animals  dying  from  apnoaa 
and  found  by  PflQger  to  have  light-red  blood  (Archiv,  i.,  p.  106),  or 
whether  the  increased  blood-pressure  could  drive  the  blood  so  quickly 
through  the  capillaries  as  to  prevent  its  giving  up  oxygen  as  usual. 

I  cannot  satisfy  myself  as  to  a  clear  explanation,  but  believe  that  dur- 
ing the  first  stage  of  cyanic  poisoning  oxidation  is  arrested,  and  that  the 
venous  condition  of  blood  found  in  later  stages  of  poisoning  is  connected 
with  spasm  of  the  pulmonary  arterioles,  and  paralysis  of  the  respiratory 
and  cardiac  muscles. 

It  would  seem  that  no  permanent  toxic  combination  is  found  with  the 
corpuscles;  they  are  not  at  once  fatally  spoiled,  nor  is  oxygen  wholly 
driven  out,  but  for  the  moment  (and  it  may  be  finally)  its  interchange 
with  tissues  is  prevented.  The  results  of  many  careful  spectroscopic  ex- 
aminations by  Preyer  and  others,  and  of  many  laborious  gas  analyses  by 
Gaethgens,  confirm  this  view:  the  red  blood  shows  still  the  absorption 
bands  of  oxyhsemoglobin,  and  the  dark  blood  those  of  haemoglobin,  with 
little  or  no  combined  oxygen:  outside  the  body,  indeed,  prussic  acid  de- 
stroys haemoglobin  (forming  a  new  compound,  cyanohaemoglobin,  which  is 
destitute  of  ozonizing  power),  but  apparently  does  not  do  so  during  life. 
Laschkewitsch  could  not  detect  such  compound,  but  on  the  contrary 
found  oxyhsemoglobin  (Reichert's  Archiv,  1868),  and  more  recently,  Hil- 
VOL.  I.— 14 


210  MATERIA    MEDICA    AND    THERAPEUTICS. 

ler  and  Wagner,  examining  blood  while  still  within  the  mesenteric  ves- 
sels, obtained  characteristic  though  feeble  lines  of  oxyhsemoglobin  (Lan- 
cet, ii.,  1877).  If  withdrawn  from  the  body,  the  dark  blood,  shaken  up 
with  oxygen,  resumes  its  normal  red  tint,  and  a  most  important  practical 
point — the  condition  just  described  may  be  remedied  during  life  by  se- 
curing access  of  additional  oxygen  by  artificial  respiration. 

Gaethgens  proved  (1)  that  the  property  of  de-oxygenated  blood  to  ab- 
stract oxygen  from  surrounding  media  is  not  destroyed  by  prussic  acid; 
(2)  that  blood  saturated  with  oxygen  exposed  to  the  action  of  prussic 
acid  gives  off  no  oxygen,  and  that  substances  which  would  usually  with- 
draw oxygen  from  fresh  blood  do  so  with  much  difficulty  under  the 
influence  of  the  acid.  Both  oxygen  and  carbonic  acid  are  excreted  in 
less  than  normal  total  quantity  during  the  poisoning  (on  account  of 
the  slow  rate  of  the  breathing),  but  not  only  is  the  actual  percentage  of 
carbonic  acid  in  the  expired  air  less  than  normal,  but  the  percentage  of 
oxygen  in  the  same  expired  air  is  greater  than  normal — i.e.,  it  has  not 
been  used  up  in  the  system. 

SYNERGISTS. — Cyanides  owe  their  activity  to  prussic  acid,  and  exert  a 
similar  action.  Cherry-laurel  water,  and  essence  of  bitter  almonds,  owe 
their  chief  properties  to  the  same  acid.  All  substances  which  hinder 
haematosis,  or  the  union  of  oxygen  with  the  blood-corpuscles — such  as 
arsenic,  antimony,  and  most  sedatives — favor  the  action  of  hydrocyanic 
acid. 

ANTAGONISTS — INCOMPATIBLES. — The  effect  of  medicinal  doses  is  les- 
sened by  diffusible  stimulants,  by  strong  acids  or  alkalies,  and  by  opium 
(Gubler).  Warmth  quickly  volatilizes  the  acid,  otherwise  it  favors  its 
action.  The  most  dependable  antidote  to  poisonous  doses  is  oxygen, 
which  is  best  introduced  into  the  system  by  artificial  respiration. 

Preyer  strongly  recommends  atropia  as  a  "  dynamic  antidote,"  since  it 
acts  upon  the  vagus  nerve  in  a  manner  contrary  to  that  of  hydrocyanic 
acid  (v.  Vegetable  Kingdom).  I  must  agree  with  Boehm  and  others  that 
his  observations  are  somewhat  wanting  in  .scientific  accuracy,  as  when  he 
speaks  of  injecting  "a  little  atropia,"  or  says  simply,  "Injected  sulphate 
of  atropia,  and  afterward  a  rather  large  dose  of  prussic  acid,  which  would 
assuredly  have  caused  death  "  ("  Versuche,"  p.  74,  36-37),  and  although 
Bartholow,  Lecorche,  and  others  have  failed  to  obtain  confirmative  evi- 
dence, still  they  hold  true  to  a  certain  extent.  A  practical  difficulty  in 
their  useful  application  must  always  be  the  extremely  rapid  course  of 
cyanic  poisoning,  and  the  (comparatively)  slow  diffusion  of  atropia; 
to  be  of  any  service,  the  alkaloid  would  have  to  be  used  almost  on  the 
instant  of  poisoning. 

Sal-ammoniac  was  strongly  recommended  by  J.  Murray  (Edinburgh 
Philosophical  Journal,  1822),  and  although  Orfilaand  Elwert  showed  that 
it  could  not  be  depended  upon  as  an  antidote,  I  think  this  and  other 


DILUTED    HYDROCYANIC    ACID.  211 

compounds  of  ammonia  well  deserve  further  trial.  Modern  observation 
credits  the  drug  with  a  power  of  directly  stimulating  the  respiratory 
centres  (v.  p.  255),  and  this,  in  addition  to  its  general  stimulating  power, 
eeems  specially  to  indicate  its  use  in  cyanic  poisoning. 

Chlorine  and  chlorine  water  have  been  used  with  advantage  by  A. 
Chevallier  and  Orfila,  but  they  are  not  manageable.  Turpentine,  though 
recommended  as  a  specific  antidote,  has  only  value  as  a  stimulant.  I  can- 
not see  that  phosphorus  offers  a  resource  of  value,  nor  can  much  be  ex- 
pected from  coffee. 

Some  indefinite  evidence  exists  as  to  an  antidotal  power  possessed  by 
strychnia.  Thus,  a  puppy  that  had  taken  £  gr.  of  prussic  acid  quickly 
recovered  after  swallowing  a  dose  of  the  alkaloid  (Medical  Times,  ii., 
1859),  and  some  other  instances  are  reported  (Lancet,  i.,  1868).  Stannius 
also  found  that  strychnia-convulsions  were  modified  by  the  acid,  but  Dr. 
Lauder  Brunton  concluded  "  that  although  the  acid  may  somewhat  lessen 
the  convulsion,  it  cannot  be  employed  as  an  antidote  to  strychnia  with 
any  hope  of  success,"  and  G.  Harley  thought  "  that  it  rather  hastened 
death  from  strychnia  "  (Medical  Times,  ii.,  1861). 

Silver  and  metallic  oxides  generally,  form  insoluble  compounds  with 
prussic  acid,  and  fresh  proto-carbonate  of  iron  has  been  recommended  as 
antidotal  by  Messrs.  Smith  ("  Medico-Chirurgical  Transactions,"  ii.,  1865); 
practically,  however,  their  influence  can  scarcely  be  exerted  quickly 
enough. 

It  remains  that  artificial  respiration  is  the  main  resource  in  all  forms 
and  stages  of  cyanic  poisoning — it  may  be  carried  out  in  the  ordinary 
methods,  or  excited  by  the  sudden  affusion  of  water,  first  cold  and  then 
hot,  thrown  over  head  and  chest.  This  does  not  exclude  the  use  of  an 
emetic,  the  application  of  ammonia  to  the  nostrils,  or  even  its  injection 
into  the  veins,  while  stimulating  frictions  and  warmth  should  be  applied 
to  the  limbs;  by  the  steady  use  of  these  means,  patients  have  revived 
from  apparently  hopeless  insensibility,  and  if  life  can  be  prolonged  for 
an  hour,  the  chances  of  recovery  become  greatly  increased. 

THERAPEUTICAL  ACTION  (EXTERNAL). —  Urticaria — Prurigo. — I  have 
seen  great  relief  given,  even  in  obstinate  forms  of  these  maladies,  by  lo- 
tions containing  hydrocyanic  acid  in  sufficient  strength.  Pereira  states 
that  he  did  not  observe  relief  in  such  cases,  but  he  seems  to  have  used 
only  2  dr.  of  acidHn  %  pint  of  water.  I  have  recommended  £  oz.  or  more 
in  10  oz.  of  liquid  (rose  water),  and  have  never  seen  ill  effects,  but  such  a 
remedy  should  not  be  placed  in  careless  hands,  nor  ordered  if  the  skin  be 
excoriated;  sometimes  a  much  smaller  proportion  will  answer  well,  and 
especially  when  mixed  with  lead  or  soda  lotion.  The  cyanide  of  potas- 
sium has  also  been  used  for  lotion  and  ointment  in  the  strength  of  £  dr. 
to  8  oz.  of  liquid,  or  1  02.  of  cerate;  a  greater  strength  has  caused  severe 
irritation. 


212  MATERIA    MEDIC  A    AND    THERAPEUTICS. 

Headache — Neuralgia, — Trousseau  used  a  lotion  of  cyanide  locally  in 
cases  of  sick  headache,  and  Fuller  recommended  the  painting  of  neuralgic 
parts  with  a  strong  preparation  of  the  acid  (£  oz.  with  2  dr.  each  of  gly- 
cerin and  water),  but  such  applications  have  rightly  fallen  into  disuse. 

Eye  Diseases. — The  same  may  be  said  of  cyanic  lotions  and  vapors  in 
the  treatment  of  eye  disease,  for  which  at  one  time  they  were  in  vogue. 
J.  V.  Solomon  recorded  numerous  cases  of  conjunctivitis  (sub-acute), 
ophthalmia,  iritis,  photophobia,  etc.,  which  were  relieved  by  applications 
of  dilute  Scheele's  acid,  1  part  in  3  (Medical  Times,  i.,  1852).  Turnbull 
invented  an  instrument  for  applying  the  strong  vapor  to  the  eye,  but  this 
sometimes  produced  serious  symptoms;  in  one  case  of  its  use,  Sir  W. 
Wilde  describes  faintness,  giddiness,  and  unconsciousness  (Medical 
Times,  i.,  1861).  Nunnely  records  that  he  found  strong  applications  to 
the  conjunctiva  poison  as  quickly  as  by  the  stomach  ("  Transactions  Prov. 
Med.  Surg.  Association,"  N.  S.,  iii.,  p.  58). 

Ringworm. — Dr.  Gee  has  found  advantage  from  a  lotion  containing 
£  oz.  of  sulphocyanide  of  potassium  in  7  oz.  of  water  with  1  oz.  of  gly- 
cerin, kept  applied  to  the  scalp.  The  effect  must  be  watched,  and  a  daily 
washing  with  soap  and  water  practised. 

THERAPEUTICAL  ACTION  (INTERNAL). — Hydrocyanic  acid  has  a  certain 
value  in  relieving  spasmodic  pain  and  irritation,  but  its  use  is  limited  by 
the  extreme  care  required  in  dosage,  and  the  risk  of  causing  unpleasant 
symptoms;  yet  to  say  with  Trousseau  that  "it  is  often  dangerous, 
almost  always  useless,  and  very  rarely  curative,"  greatly  overstates  the 
facts. 

Gastrodynia — Enterodynia. — Cases  described  under  these  names,  and 
which  seem  to  be  frequently  of  neuralgic  type,  are  often  quickly  relieved 
by  suitable  doses  of  prussic  acid.  Pereira  gives  instances  of  very  severe 
spasmodic  pain,  where  there  was  no  complaint  of  pyrexia,  of  faintness, 
nor  of  any  ordinary  symptoms  of  dyspepsia;  the  pain  was  such  as  to  lead 
to  suspicion  of  organic  disease,  but  it  disappeared  under  the  use  of  the 
acid.  In  one  case  it  was  seated  in  the  intestine,  came  on  about  2  P.M., 
and  lasted  until  night,  unrelieved  by  many  remedies  until  this  one  was 
used,  and  Pereira  made  the  further  observation  that  its  action  is  exerted 
quickly,  and  either  produces  complete  relief  or  none  at  all.  Sir  T.  Wat- 
son "  has  seen  more  rapid  and  decided  relief  from  it  in  gastrodynia  than 
from  anything  else!" 

Dyspepsia. — Dr.  Elliotson,  in  a  special  treatise  on  the  subject,  makes 
several  groups  of  cases  in  which  he  found  prussic  acid  extremely  useful; 
some  were  marked  by  pain  and  tenderness  only,  others  by  flatulence, 
nausea,  anorexia,  liver-troubles,  and  vertigo,  others  again  by  pyrosis, 
heartburn,  and  palpitation  ( Medico-  Chirurgical  Review,  i.,  1821).  A. 
T.  Thompson  made  somewhat  similar  observations,  especially  noting 
benefit  when  the  tongue  was  hot,  red,  and  sore  (Dispensatory).  Bailey 


DILUTED    HYDROCYANIC    ACID.  213 

also  published  illustrative  cases  (London  Medical  Repository,  1828),  and 
alluded  to  its  value  when  there  was  sympathetic  heart-disturbance,  pal- 
pitation, etc.  In  such  cases,  it  is  still  in  frequent  use,  although  other 
remedies  may  be  required  if  there  be  marked  symptoms  of  unhealthy  se- 
cretion. Disappointment  as  to  its  effects  may  be  sometimes  traced  to 
the  inertness  from  age  of  the  preparation,  or  to  admixture  with  other 
drugs. 

Vomiting. — The  acid  is  useful  in  the  vomiting  of  fever,  and  in  sym- 
pathetic vomiting,  and  is  sometimes  indicated  in  that  of  ordinary  gastric 
derangement:  it  may  be  added  to  effervescent  mixtures,  or  to  bismuth, 
but  as  a  rule  is  better  given  alone  in  distilled  water.  In  some  patients, 
or  in  some  conditions,  and  more  especially  when  the  dose  is  too  large, 
nausea  and  vomiting  seem  to  be  increased  or  caused  by  the  drug,  and 
then  it  is  better  omitted:  on  the  other  hand,  I  have  seen  severe  cases 
recover  with  6  to  8  min.  doses,  when  smaller  doses  and  all  ordinary  means 
had  failed.  In  simple  intestinal  obstruction,  even  when  faecal  vomiting 
had  occurred,  I  have  used  10  min.  doses  with  the  effect  of  staying  the 
vomiting,  but  care  is  necessary  in  watching  the  results.  Dr.  Brinton 
found  the  acid  useful  in  the  vomiting  of  gastric  ulcer;  Dr.  Harley  com- 
bined it  with  bismuth,  opium,  etc.,  in  that  of  enteric  fever;  Pereira 
recommended  it  in  the  vomiting  and  purging  of  phthisis,  and  even  of 
cholera,  and  it  may  well  be  tried  in  the  "  nervous  "  form  of  vomiting, 
that  connected  with  pregnancy,  or  with  cerebral  concussion  or  disorder. 

Phthisis. — In  the  early  part  of  this  century  Dr.  Granville  published  a 
small  treatise  "  to  establish  the  claims  of  a  new  and  powerful  remedy,"  and 
in  his  second  edition  (1820)  congratulates  himself  on  the  conclusive  and 
numerous  facts  which  have  proved  he  was  "  not  indulging  in  the  chim- 
eras of  a  revery  "  when  he  recommended  the  prussic  acid  for  treating, 
if  not  curing,  consumption.  Being  before  the  days  of  physical  diagnosis, 
his  cases  scarcely  bear  examination,  and  his  peculiar  egotistic  style  jars 
upon  the  professional  reader;  but  he  may  be  credited  with  pointing  out 
the  relief  often  given  to  the  general  nervous  irritability,  the  dyspepsia 
and  harrassing  cough  of  phthisical  subjects.  The  exaggerated  views  en- 
tertained both  by  the  eminent  Majendie  and  by  Granville  as  to  its  powers 
of  checking  the  disorder  and  curing  asthma,  chronic  cough,  etc.,  have 
not  been  verified  by  later  experience.  We  can  only  say  that  it  is  a  use- 
ful palliative  for  the  irritative  dry  cough,  especially  in  cases  when  morphia 
is  not  suitable,  and  that  with  alkalies  and  calumba  it  is  often  serviceable 
in  phthisical  dyspepsia. 

Whooping- Cough— "Nervous  Cough."— Dr.  Granville  states,  "  with- 
out presumption,"  that  in  almost  every  case  of  whooping-cough  this 
medicine,  given  early,  removes  the  disease  (p.  64),  and  Dr.  Hamilton  Roe, 
in  a  special  treatise  (1838),  records  equally  excellent  results.  He  was 
rather  in  advance  of  his  time  in  concluding  pertussis  to  be  not  always 


214  MATERIA   MEDICA    AND    THERAPEUTICS. 

inflammatory,  but  "a  nervous  affection,  having  its  seat  in  the  mucous 
membrane  of  the  bronchi  and  the  pneumogastric  nerve,"  and  for  the 
"  nervous  element,"  i.e.,  the  peculiar  whooping  or  spasmodic  cough,  he 
valued  prussic  acid  more  than  opium,  belladonna,  or  any  other  remedies 
then  in  use:  he  gave  very  full  doses,  such  as  f  min.  of  Scheele's  acid  to 
infants,  and  1£  drop  every  quarter-hour  for  twelve  hours  to  a  child  of  ten 
years.  I  think  this  another  illustration  of  the  benefit  to  be  obtained 
from  the  medicine  when  it  may  be  justifiably  and  yet  cautiously  pressed, 
but  for  average  practice  it  would  be  dangerous,  and  I  agree  with  Sir  T. 
Watson,  who  thinks  the  remedy  in  such  doses  "too  gigantic  for  such 
young  subjects;  "  also  with  Dr.  C.  West,  who  finds  it  "  sometimes  magi- 
cal "  for  diminishing  the  frequency  and  severity  of  the  paroxysm,  but 
sometimes  inert,  sometimes  poisonous.  Dr.  Atlee,  judging  from  two 
hundred  cases,  gives  a  most  favorable  report  of  it  (American  Journal, 
vol.  x.),  and  my  own  experience  is  decidedly  in  the  same  direction — the 
more  purely  nervous  the  paroxysms,  the  better  will  the  remedy  act, 
though  some  difficulty  in  graduating  its  dose  will  always  remain:  also, 
as  is  well  known,  the  results  obtained  from  remedies  unaccountably  vary 
in  different  epidemics  and  different  individuals.  In  other  forms  of  irrita- 
tive cough,  connected  with  spinal  or  vagus  irritation,  I  have  seen  more 
benefit  from  this  acid  than  from  any  ordinary  sedatives;  and  the  long- 
recognized  clinical  value  of  the  drug  in  such  conditions  is  of  marked  in- 
terest taken  in  connection  with  the  special  effect  on  the  medulla  and 
vagus,  mentioned  under  physiological  action. 

Asthma. — Much  relief  may  be  given  to  patients  suffering  from  simple 
spasmodic  asthma,  by  small  and  repeated  doses  of  prussic  acid. 

Palpitation. — Whether  palpitation  arises  from  cardiac  hypertrophy 
or  from  ordinary  functional  derangement  of  the  heart,  dependent  upon 
nervous  exhaustion  or  dyspepsia,  hydrocyanic  acid  will  often  prove  use- 
ful. 

Vertigo — Cerebral  Irritation — Mania. — The  acid  certainly  exerts 
some  control  over  exalted  cerebral  function,  whether  by  acting  through 
the  circulation  or  otherwise.  Vertigo,  especially,  if  dependent  on  gastric 
derangement,  may  be  relieved  by  it.  Dr.  McLeod  has  furnished  evidence 
of  its  calmative  power  in  acute  mania  and,  acute  melancholia,  recording 
forty  cases,  in  most  of  which  the  relief  given  to  violent  excitement  was 
marked  and  rapid;  about  5  min.  of  Scheele's  acid  was  the  usual  dose,  or 
3  min.  injected  under  the  skin  (Medical  Times,  i.,  1862). 

In  Delirium  Tremens,  Dr.  Dow  has  seen  it  serviceable  (British  Medi- 
cal Journal,  i.,  1873),  and  Dr.  Maudsley  recommends  its  combination 
with  digitalis  (Practitioner,  January,  1869,  vol.  ix.). 

PREPARATIONS  AND  DOSE. — Acidum  hydrocyanicum  dilutum  (con- 
tains 2  per  cent,  of  anhydrous  acid):  dose,  2  to  8  min.  Vapor  acidi 
hydrocyanici  (inhalation)  is  prepared  with  10  to  15  min.  in  1  fl.  dr.  of 


NITRIC    ACID.  215 

cold  water.  "  Mix  in  a  suitable  apparatus,  and  let  the  vapor  that  arises 
be  inhaled."  Lotio:  2  dr.  to  £  oz.  in  £  pint  of  rose  water;  it  should  not 
be  applied  to  an  abraded  skin.  Anhydrous  prussic  acid  being  one  of  the 
most  active  and  rapid  poisons  known,  should  never  be  prescribed;  neither 
should  Scheele's  prussic  acid,  which  contains  4  per  cent,  of  anhydrous 
acid. 

[PREPARATION,  U.S. P. — Acidum  hydrocyanicum  dilutum,  contains 
2  per  cent,  of  anhydrous  acid.] 


ACIDUM  NITRICUM— NITRIC  ACID— AQUA  FORTIS, 

HNOS,=63. 

Nitric  acid,  the  highest  known  oxide  of  nitrogen,  may  be  detected  in 
the  atmosphere  after  thunder-storms,  for  electricity  determines  the  neces- 
sary combination  of  the  gases.  United  with  potash,  soda,  lime,  or  am- 
monia, it  forms  a  nitrate  which  is  found  native  in  efflorescence  on  the  soil 
of  some  countries;  it  occurs,  also,  in  some  minerals  and  in  certain  plants, 
e.g.,  as  potash  nitrate  in  pareira  root. 

PREPARATION. — Being  a  volatile  acid,  it  may  be  prepared  from  any 
nitrate  (usually  a  nitrate*  of  potash  or  soda),  by  distilling  it  with  the 
more  stable  sulphuric  acid,  when  sulphate  of  potash  is  formed,  and  nitric 
acid  being  set  free,  rises  with  the  vapor  of  water  and  condenses  in  the 
receiver.  KNO.  +  I^SO^HNC^  +  KHSO,.  Of  anhydrous  acid,  it  con- 
tains 60  per  cent. 

The  dilute  nitric  acid  contains  6  oz.  of  the  strong  acid  in  31  oz.  of 
distilled  water,  or  about  1  min.  in  every  5  min.  Heat  is  developed  dur- 
ing its  preparation,  and  condensation  of  volume  occurs. 

CHARACTERS  AND  TESTS. — The  pure  acid,  protected  from  light,  re- 
mains colorless,  but  if  exposed  becomes  yellowish  in  color,  from  develop- 
ment of  orange-colored  oxides,  mainly  Na04  (nitric  peroxide);  at  a  sp. 
gr.  of  1.42  it  is  a  stable  compound,  boils  at  250°,  and  distils  over  un- 
changed; it  has  a  very  sour,  corrosive  taste,  and  an  acrid,  suffocating 
odor;  its  affinity  for  water  is  great,  and  the  white  fumes  which  it  emits 
on  exposure  are  caused  by  the  combination  of  its  invisible  vapor  with 
atmospheric  moisture  forming  a  cloud  of  minute  drops. 

A  good  test  for  nitric  acid  is  its  action  on  metallic  copper  or  iron; 
when  undiluted  and  poured  on  them,  it  gives  dense  red  vapors  of  per- 
oxide of  nitrogen  and  other  oxides,  but  if  first  diluted,  a  colorless  gas, 
nitric  oxide,  NO,  is  given  off,  which  changes  into  peroxide,  N904,  and 
becomes  orange-red  in  color  on  contact  with  the  air.  If  the  colorless 
gas,  NO,  be  passed  into  a  solution  of  protosulphate  of  iron,  it  will  com- 


216  MATERIA   MEDICA   AND    THERAPEUTICS. 

bine  with  a  portion  of  it,  causing  a  dark  brown  color.  Morphia  and 
brucia  are  colored  bright  red  by  the  acid. 

There  is  no  precipitation  test  for  nitric  acid,  because  all  neutral  nitrates 
are  soluble,  but  its  adulteration  with  sulphuric  or  hydrochloric  acid  is 
detected  by  chloride  of  barium  and  nitrate  of  silver  respectively. 

Nitric  acid  is  a  powerful  oxidizing  agent,  and  is  used  in  pharmacy 
to  prepare  the  nitrates  of  different  metals;  also  for  the  making  of  certain 
organic  compounds,  as  gun-cotton,  nitrite  of  amyl,  etc. 

ABSORPTION  AND  ELIMINATION. — Dilute  nitric  acid  in  medicinal  doses 
is  diffusible  and  readily  absorbed.  In  the  blood  it  either  combines  with 
alkaline  bases  forming  nitrates,  or  it  circulates  in  a  free  state,  or  loosely 
joined  (invisque)  with  albumen  (Gubler) :  it  cannot  be  detected  free  in 
the  blood  by  analysis.  It  is  eliminated  mainly  by  the  urine  as  nitrate  of 
potash  or  soda,  not  as  free  acid;  yet  it  highly  increases  the  acidity  of  the 
secretion  by  liberating  acids  weaker  than  itself  (such  as  uric  and  lactic 
acids)  from  their  combinations.  From  its  effects  upon  the  intestinal 
glandular  structure,  and  from  the  comparatively  small  amount  passed  in 
the  urine,  it  is  probable  that  some  is  excreted  by  the  lower  bowel. 

PHYSIOLOGICAL  ACTION  (EXTERNAL). — Strong  nitric  acid  applied  but 
for  a  moment,  stains  organic  tissue  yellow,  and  leads  to  desquamation  of 
the  epidermis;  if  applied  firmly  and  for  longer  time,  it  exerts  a  potent 
caustic  effect,  due  to  abstraction  of  the  water  from  the  tissues  and  com- 
bination of  the  acid  with  alkaline  bases;  xantlfo-proteic  or  -picric  acid  is 
also  formed,  and  the  part  becomes  yellow. 

Dilute  solutions  exert  a  stimulant,  moderately  astringent  effect;  by 
continued  contact  they  change  most  animal  and  vegetable  substances  into 
oxalic,  malic,  or  carbonic  acids  (H.  C.  Wood:  "Elements,"  2d  ed.,  p.  96). 
Nitric  peroxide  is  an  efficient  but  irritating  disinfectant. 

PHYSIOLOGICAL  ACTION  (INTERNAL). — For  a  general  statement  as  to 
the  action  of  acids  on  the  organism,  reference  may  be  made  to  hydro- 
chloric acid. 

Digestive  System. — Given  internally,  in  medicinal  doses,  dilute  nitric 
acid  exerts  a  stimulant  effect  on  the  glandular  system  of  the  alimentary 
canal,  and  some  tonic  bracing  effect  on  the  mucous  membrane,  so  that 
appetite  is  improved  by  it,  and  undue  secretion  lessened;  this  is  probably 
owing  to  a  direct  local  action.  Salivation  sometimes  occurs  under  the  use 
of  nitric  acid,  either  in  consequence  of  the  gastric  irritation,  or  of  direct 
stimulation  of  the  salivary  glands  by  the  medicine.  It  is  commonly  cred- 
ited with  some  power  of  stimulating  the  secretion  and  excretion  of  bile. 

Large  doses  act  like  other  violently  corrosive  irritant  poisons.  In  a 
case  that  proved  fatal  on  the  eighth  day  after  swallowing  1  dr.  of  the 
strong  acid,  the  oesophagus  and  stomach  were  found  inflamed  and  ulcer- 
ated, the  colon  was  in  the  same  state,  but  the  small  intestine  was  sound; 
suppression  of  urine  had  occurred. 


NITRIC    ACID.  217 

SYNEKGISTS — ANTAGONISTS. — The  same  as  those  of  sulphuric  acid. 

THERAPEUTICAL  ACTION  (EXTERNAL).— Disinfectant.  —Nitrous  fumes 
may  be  generated  by  the  action  of  sulphuric  acid  on  nitrate  of  potash. 
They  efficiently  disinfect  unhealthy  wards,  prisons,  etc.,  but  the  use  of 
less  irritating  substances  has  practically  replaced  this  method. 

Phagedcenic  Ulceration. — In  cases  of  sloughing  chancre,  of  phage- 
daena,  of  hospital  gangrene,  etc.,  when  it  is  necessary  to  destroy  por- 
tions of  diseased  tissue,  and  to  stimulate  to  healthy  action,  strong  nitric 
acid  is  one  of  the  best  caustics  in  use.  The  affected  part  should  be 
cleansed  and  dried,  so  that  the  acid  be  not  too  diluted  by  secretion,  the 
neighboring  parts  should  be  protected  by  oil  or  ointment,  and  the  caustic 
then  thoroughly  applied  with  a  glass  brush,  splinter  of  wood,  or  pledget 
of  lint,  until  a  firm  dry  yellowish  mass  is  formed;  the  pain  is  at  first  se- 
vere, but  soon  subsides  under  cold  water  dressings,  the  eschar  formed  is 
not  very  deep,  and  usually  separates  in  one  or  two  days;  the  application 
may  sometimes  require  to  be  repeated. 

Bubo. — The  strong  acid  may,  with  advantage,  be  lightly  pencilled 
over  torpid  suppurating  buboes,  to  destroy  the  integument  and  stimulate 
to  healthy  discharge;  should  a  sinus  be  formed,  the  upper  wall  should  be 
touched  in  the  same  manner  (Lancet,  ii.,  1867,  p.  796). 

Lupus. — The  same  application  is  indicated  for  the  indolent  edges  of 
an  ulcerating  lupus,  though  acid  nitrate  of  mercury  is  perhaps  better. 

Uterine  Disease. — Dr.  Lornbe  Atthill  has  had  the  best  results  from 
applications  of  strong  nitric  acid  to  the  interior  of  the  uterus,  in  cases  of 
fungoid  granulation  and  excessive  hemorrhage:  lint  bound  on  a  uterine 
probe  conveys  the  caustic  through  a  small  speculum  placed  in  the  cervix 
(Obstetrical  Journal,  June,  1873,  and  Treatise).  It  is  a  good  application 
also  in  chronic  inflammatory  disease  of  the  same  part  and  in  granular 
erosion  of  cervix  if  there  be  not  excessive  tenderness  (British  Medical 
Journal,  i.,  1876).  H.  Lee  has  found  the  acid  good  in  uterine  disease,  if 
the  mucous  membrane  be  not  too  much  thickened;  it  is  important  that  it 
be  not  diluted  by  secretion,  and  that  an  alkaline  injection  be  used  after 
it  (Lancet,  i.,  1874).  As  injurious  effects  have  sometimes  followed  the 
use  of  nitrate  of  mercury  and  of  strong  iron  solutions,  I  myself  prefer 
the  nitric  acid  for  vaginal  and  uterine  disease  of  the  kinds  named,  but  in 
cases  of  hemorrhage  from  the  vagina  or  uterine  neck,  connected,  e.g., 
with  carcinoma,  I  think  the  perchloride  or  persulphate  of  iron  mixed  with 
glycerin,  are  better  haemostatics. 

Internal  Haemorrhoids. — It  has  been  thought  that  strong  nitric  acid 
would  supersede  all  operative  interference  in  this  disorder,  but  its  cura- 
tive power  is  really  somewhat  limited. 

Its  local  application  is  only  useful  in  small  granular  piles,  and  in  "  vel- 
vety "  conditions  of  the  mucous  membrane;  it  checks  the  bleeding,  but 
severe  hemorrhage  may  occur  when  the  slough  separates.  One  or  two 


218  MATERIA   MEDIC  A    AND    THERAPEUTICS. 

applications  ought  to  suffice  for  the  cure  of  such  a  condition,  but  for  large 
masses,  or  for  haemorrhoids  with  narrow  vascular  attachments,  other  treat- 
ment is  better.  Billroth,  however,  reports  much  success  with  nitric  acid 
in  most  forms  of  internal  hasmorrhoids,  but  especially  in  the  flat  form: 
after  protrusion,  he  applies  the  remedy  till  the  part  is  "  stiff  and  yellow- 
ish-gray in  color,"  and  then  oils  it  well — he  notes  the  importance  of  not 
touching  sound  parts  with  the  acid,  for  it  causes  great  pain  (Ranking,  i., 
1872).  Dr.  Houston  first  proposed  this  treatment  (Dublin  Medical  Jour- 
nal, vols.  xxiii.-xxvi.);  and  Mr.  Henry  Smith  has  used  it  extensively,  and 
written  in  its  favor. 

In  less  severe  cases  where  the  parts  bleed  and  are  somewhat  swollen, 
Dr.  Ringer  recommends  a  lotion  containing  1  to  1£  dr.  dilute  acid  to  £ 
pint  water. 

Prolapsus  Hecti. — If  the  strong  acid  be  applied  in  one  or  two  hori- 
zontal bands  to  the  prolapsed  mucous  membrane  of  the  rectum,  in  such  a 
degree  as  to  cause  moderate  but  not  too  deep  sloughing,  these  bands,  on 
healing,  will  leave  cicatrices  which  by  their  contraction  are  often  suffi- 
cient to  cure  the  complaint.  In  children,  in  whom  prolapsus  ani  is  rather 
common,  benefit  is  often  obtained  from  bathing  the  part  with  a  weak  ni- 
tric acid  lotion,  and  giving  the  same  acid  internally. 

Condylomata  on  the  limbs  or  genitals,  especially  when  of  a  syphilitic 
origin,  disappear  under  the  external  use  of  nitric  acid. 

Warts  and  Corns.—  Erasmus  Wilson  recommends  nitric  acid  for  the 
treatment  of  callosities,  the  cauterized  portion  being  removed  occasion- 
ally by  the  knife.  I  have  used  nitric  acid  extensively  for  the  removal  of 
moles  on  the  face;  the  cicatrices  are  hardly  visible. 

Ncevi. — Superficial  nsevi  may  be  safely  destroyed  by  painting  with 
strong  nitric  acid;  Mr.  T.  Holmes  speaks  highly  of  this  method.  Due 
precaution  should  be  taken  to  protect  the  sound  skin,  and  an  alkaline  lo- 
tion should  be  used  afterward.  If  the  affected  part  be  extensive,  a  por- 
tion only  should  be  treated  at  one  time,  the  caustic  being  applied  about 
every  second  day,  until  its  full  effect  be  produced  (Lancet,  ii.,  1866,  and 
1867).  For  small  naevi  on  the  face,  I  can  recommend  puncture  with  a 
needle  dipped  in  the  acid:  it  is  safe,  effective,  and  leaves  comparatively 
little  scar. 

Indolent  Ulcers. — For  ordinary  indolent  or  moderately  sloughing  ul- 
ceration,  a  lotion  containing  nitric  acid  diluted,  about  1  dr.  in  £  pint  of 
water,  is  a  good  dressing. 

Pruritus. — A  similar  lotion  will  often  relieve  itching  in  papular  and 
neurotic  diseases,  such  as  lichen  and  prurigo;  it  may  be  conjoined  with 
prussic  acid,  or  with  the  liquor  carbonis  detergens. 

Alopecia. — The  acid,  diluted  with  so  much  olive  oil  as  will  prevent  the 
caustic  though  not  the  stimulant  effects,  makes  a  good  liniment  in  some 
cases  of  falling  off  of  the  hair  from  debility. 


NITRIC    ACID.  219 

THEBAPEUTICAL  ACTION  (INTERNAL).— Dyspepsia— Debility.—  Dilute 
nitric  acid  is  a  serviceable  tonic  in  cases  of  nerve-debility  and  of  conva- 
lescence from  acute  disease,  when  appetite  and  digestive  power  are  im- 
paired. It  acts  well  in  combination  with  a  few  minims  of  tincture  of 
nux  vomica,  stimulating  the  gastric  glands  and  the  biliary  secretions, 
and  may  be  given  between  meals,  or  shortly  before  or  after,  according  to 
the  conditions  already  mentioned  under  hydrochloric  acid  (v.  p.  197). 

Hepatic  Disorder. — Nitric  acid  has  long  been  held  in  repute  for  the 
treatment  of  chronic  hepatic  congestion,  or  chronic  hepatitis,  especially 
when  occurring  in  Anglo-Indians,  and  after  mercurials  have  been  used. 
Dr.  Murchison  met  with  marked  improvement,  even  in  cases  of  waxy 
liver,  from  the  continued  use  of  nitric  acid  with  vegetable  bitters  ("  Dis- 
eases of  Liver,"  1868,  p.  33),  but  in  later  writings  he  remarks  that  there 
is  no  evidence  of  its  assisting  bile-flow,  and  that  its  action  is  less  direct 
than  that  of  alkalies;  that  in  congestion  (of  acute  character),  or  when 
lithiasis  is  present,  it  either  does  no  good,  or  aggravates  the  malady, 
though  it  may  relieve  the  dyspepsia  of  debility:  he  sometimes  gives  alka- 
lies before  a  meal,  and  acid  after  (British  Medical  Journal,  i.,  1874). 
R.  Martin,  Thudichum,  and  indeed  the  majority  of  writers  twenty  years 
ago,  allowed  to  nitric  acid  a  larger  sphere  of  usefulness  in  hepatic  disor- 
der, jaundice,  etc.;  it  was  presumed  to  "lixiviate  biliary  deposits,  tone 
digestion,  and  act  antiseptically  "  (British  Medical  Journal,  ii.,  1860). 
Annesley  noted  that  it  acted  better,  the  more  freely  it  was  diluted — he 
used  it  in  chronic  splenic  disorder.  I  have  found  nitric  acid  useful  in 
chronic  hepatitis,  when  watery  diarrhoea  and  constipation  occur  alter- 
nately. 

Phosphatic  Urine —  Chronic  Cystitis. — Sir  B.  Brodie  constantly  em- 
ployed strong  nitric  acid,  in  full  doses — 30  min.  or  more — largely  diluted, 
and  given  in  divided  doses  during  the  day,  for  phosphatic  and  alkaline 
urine.  In  cases  of  chronic  cystitis,  and  even  of  phosphatic  calculus,  he 
also  employed  local  injections  containing  1  to  2 "min.  of  the  strong  acid 
in  the  ounce  of  warm  water.  The  best  mode  of  administering  nitric  acid 
under  these  conditions  is  to  give  5  to  10  min.  of  the  dilute  acid  in  1  or  2 
oz.  of  decoction  of  pareira  brava  every  three  or  four  hours. 

Diarrhoea. — When  the  dejections  are  frequent,  serous  or  "  watery  " 
in  character,  especially  if  markedly  alkaline,  and  if  there  be  no  evidence 
of  acute  inflammation  and  not  much  pain,  then  nitric  acid  acts  well,  and 
in  cases  of  profuse  purging  from  summer  heat,  and  in  the  diarrhoaa  of 
phthisis,  it  has  a  deserved  repute:  if  necessary,  it  may  be  combined  with 
a  small  quantity  of  opium.  In  dysenteric  diarrhoea  with  tenesmus, 
blood,  and  profuse  discharge  of  mucus,  nitric  acid  acts  well.  Dr.  Hope 
had  reason  to  prefer  the  dilute  nitrous  to  the  nitric  acid;  he  gave  15-min. 
doses,  with  laudanum  and  camphor  water,  in  most  forms  of  diarrhoea  and 
chronic  dysentery,  with  much  success.  Dr.  H.  C.  Wood  found  it  succeed 


220  MATEEIA    MEDIC  A    AND    THERAPEUTICS. 

in  some  cases  where  nitric  acid  had  failed:  it  is,  however,  unstable,  and 
requires  to  be  recently  prepared. 

Constipation. — Dr.  Graves  says,  "  In  constipated  habits  I  have  occa- 
sionally derived  very  remarkable  benefit  from  the  use  of  nitric  acid  given 
in  sufficient  doses.  It  seems,  like  the  carbonate  of  iron,  to  possess  the 
advantage  of  combining  tonic  with  aperient  qualities  "  ("  Clinical  Medi- 
cine," ii.,  p.  215).  I  think  that  this  different  action  of  the  medicine  de- 
pends upon  dose,  and  perhaps  combination,  and  is  not  contradictory  to 
that  mentioned  in  the  last  section.  Nitric  acid  in  small  or  moderate 
doses  is  astringent,  especially  if  prescribed  with  opium;  but  nitric  acid  in 
futt  doses  has  an  aperient  effect,  especially  in  combination  with  bitter  in- 
fusion, such  as  gentian;  this  may  be  traced  either  to  direct  intestinal 
irritation  or  to  hepatic-  stimulation. 

Otorrhcea  occurring  in  scrofulous  children  or  in  syphilitic  patients,  is 
often  quickly  controlled  by  a  course  of  this  acid. 

Purulent  Ophthalmia,  with  extensive  ulceration  of  the  cornea,  whether 
of  a  gonorrhoeal  or  scrofulous  form,  is  much  benefited  by  a  course  of  5  to 
10  min.  of  the  dilute  acid  three  or  four  times  a  day,  together  with  local 
treatment. 

Fevers. — Dr.  Osborne  has  recorded  a  good  experience  of  nitric  acid  in 
typhoid  fever  (Lancet,  ii.,  1862),  and  Dr.  Bailey  (U.  S.)  inintermittents — 
he  prescribed  it  to  relieve  profuse  sweating,  and  unexpectedly  found  a 
curative  effect  on  the  ague:  of  ninety  cases,  eighty  made  a  rapid  recov- 
ery. Dr.  Hammond  has  corroborated  his  results  (Ranking,  1862). 

Secondary  Syphilis. — A  course  of  dilute  nitric  acid  will  often  be  of 
service  in  later  syphilitic  cachexia,  especially  after  mercurials  have  been 
used,  and  in  debilitated  subjects.  It  benefits  ulcerations  of  the  mouth, 
throat,  and  nose,  and  also  periosteal  swellings,  and  may  be  applied  at  the 
same  time  in  the  form  of  bath — 1  to  2  oz.  for  each  bath.  Mercurial  sali- 
vation is  relieved  by  the  acid. 

Skin  Diseases. — In  chronic  syphilitic  cutaneous  eruption,  such  as 
rupia  or  psoriasis,  this  acid  has  been  rightly  commended.  In  ordinary, 
non-specific  disorder,  it  is  indicated  whenever  general  debility  is  a  marked 
symptom,  and  especially  when  nerve-power  is  impaired.  Dr.  Tilbury  Fox 
frequently  gave  it,  in  conjunction  with  a  bitter  tonic,  for  psoriasis  in 
weakly  subjects. 

Chronic  Laryngeal  Congestion. — In  this  malady,  when  brought  on 
by  excessive  vocal  exertion,  as  in  singers  and  readers,  5  to  6-min.  doses  of 
dilute  nitric  acid  in  sugared  water  have  been  found  very  useful,  bracing 
up  the  relaxed  membrane  and  throat  follicles,  and  relieving  hoarseness; 
also  in  chronic  laryngitis,  dependent  upon  a  syphilitic  taint,  it  is  of  much 
use. 

Chronic  Bronchitis. — I  agree  with  some  good  observations  made  by 
Dr.  Glover,  drawing  attention  to  the  benefit  obtained  sometimes  from 


DILUTE    PHOSPHORIC    ACID.  221 

nitric  acid  in  cases  of  chronic  catarrh  and  bronchitis  when  secretion  is 
fairly  free,  when  nerve-exhaustion  is  a  prominent  symptom,  and  when 
ammonia  and  expectorants  fail  to  relieve  (Lancet,  i.,  1865);  this  fact  de- 
serves more  attention  than  it  has  yet  received.  Dr.  Glover  combines 
nitrous  ether  with  the  acid,  and  sometimes  tinct.  camph.  co.  is  also  indi- 
cated, the  precipitated  camphor,  etc.,  being  readily  suspended  in  cetraria 
or  mucilage. 

Pertussis. — Nitijc  acid  has  been  found  by  some  observers  valuable  in 
relieving  the  spasmodic  recurrent  attacks  of  cough,  and  lessening  profuse 
expectoration;  and  it  may  certainly  be  credited  with  tonic  bracing  action 
on  the  faucial  and  laryngeal  membranes.  Arnoldi,  who  introduced  this 
mode  of  treatment,  ordered  as  much  acid  as  would  render  a  tumblerful 
of  sugared  water  "  like  lemon  juice,"  to  be  taken  every  three  or  four 
hours.  Dr.  Gibb,  who  reported  the  best  results,  gave  as  much  as  10  min. 
to  infants,  and  40  min.  to  children  of  ten  years;  and  some  other  practi- 
tioners have  used  this  medicine  with  success,  as  Ussher  (Medical  Times, 
i.,  1862),  and  Berry — in  an  epidemic  at  Lancaster — who  found  it  effective, 
safe,  and  cheap  (Medical  Times,  i.,  1873).  I  have  been  reluctant  to  press 
it  for  fear  of  injuring  teeth,  and  when  I  have  used  it  as  freely  as  could  be 
borne,  I  have  not  seen  definite  benefit. 

PREPARATIONS  AND  DOSE. — Acidum  nitricum — Aqua  fortis :  dose  1 
to  3  min.  freely  diluted.  Acidum  nitricum  dilutum  :  dose,  10  to  30  min. 
freely  diluted. 

[PREPARATIONS,  U.S. P. — Acidum  nitricum,  sp.  gr.  1.420,  Acidum 
nitricum  dilutum :  nitric  acid  3  troyounces,  water  sufficient  to  make  1 
pint.] 

ADULTERATIONS. — Chiefly  sulphuric  and  hydrochloric  acids. 


ACIDUM    PHOSPHORICUM     DILUTUM— DILUTE    PHOS- 
PHOEIC  ACID,  H3PO4,=98. 

This  acid  is  rather  widely  diffused,  being  found  free  or  combined  with 
alkaline  and  earthy  bases  in  soils,  and  in  many  vegetables  and  fruits,  such 
as  wheat,  potatoes,  rice,  lemons,  etc.,  also  in  fish,  and  in  the  bones,  nerves, 
and  flesh  of  animals,  and  according  to  Marcet,  more  'in  the  lungs  than  in 
other  parts;  also  in  the  urine  and  other  secretions. 

PREPARATION.— The  officinal  (tribasic)  acid  is  prepared  by  distilling 
phosphorus  with  dilute  nitric  acid  by  the  aid  of  gentle  heat;  some  of  the 
latter  acid  passes  over  in  vapor,  and  therefore  the  distillate  is  returned  to 
the  retort  occasionally  in  order  to  prevent  loss:  it  is  finally  concentrated  to 
a  syrupy  consistence  (heat  being  used  to  get  rid  of  nitrous  fumes),  and 
the  resulting  strong  phosphoric  acid  is  diluted  with  water  to  a  sp.  gr.  of 
1.08,  which  represents  about  14  per  cent,  of  acid. 


222  MATERIA    MEDICA    AND    THERAPEUTICS. 

CHARACTERS  AND  TESTS. — Tribasic  or  orthophosphorous  acid  is  a  color- 
less, inodorous  liquid,  of  acid,  not  unpleasant  taste,  and  even  when  con- 
centrated, not  corrosive,  nor  coagulating  albumen.  It  gives  with  ammo- 
nio-nitrate  of  silver,  a  canary-yellow  precipitate  of  phosphate. 

There  are  two  other  forms  of  phosphoric  acid,  not  officinal,  but  of 
much  interest  to  the  chemist.  If  heat  be  applied  to  the  common  acid  it 
loses  water,  and  its  first  anhydride  (pyrophosphoric  or  bibasic  acid,  H4P4 
O7)  is  produced:  by  a  higher  heat,  more  water  is  driven  off,  and  its  second 
anhydride,  glacial  or  metaphosphoric  or  monobasic  acid  HPO3,  is  formed. 
This  is  in  the  U.  S.  Pharmacopoeia,  and  is  a  colorless,  ice-like,  deliques- 
cent solid:  it  is  the  only  form  which  coagulates  albumen. 

All  soluble  phosphates  give  a  white  crystalline  precipitate  with  sul- 
phate of  magnesia,  after  the  addition  of  sal-ammoniac  and  liquor  ammonias 
(ammonio-magnesian  phosphate,  or  "triple  phosphate" — MgNH4PO4). 

ABSORPTION"  AND  ELIMINATION. — Phosphoric  acid  is  readily  absorbed 
by  the  stomach.  Ordinary  doses  combine  with  alkalies — potash  or  soda 
salts — probably  displacing  them  from  combination  with  weaker  acids, 
lactic  or  carbonic,  and  forming  phosphates;  after  larger  or  poisonous 
doses,  Hoffmann  states  that  he  has  found  it  free  in  the  blood  or  loosely 
combined  with  albumen  (Journal  de  Chemie,  June,  1868). 

As  phosphate  it  is  mainly  eliminated  in  the  urine,  and  Booker  found 
the  excretion  of  potash  phosphate  especially  increased  under  its  use:  some 
acid  may  possibly  be  eliminated  in  a  free  state. 

PHYSIOLOGICAL  ACTION. — The  action  of  phosphoric  acid  bears  a  gen- 
eral resemblance  to  that  of  sulphuric  acid,  but  in  medicinal  doses  it  is  less 
liable  to  irritate  the  stomach  or  interfere  with  digestion,  and  it  exerts  a 
more  stimulating  effect  on  the  general  system :  it  has  a  more  pleasant 
taste  than  the  other  inorganic  acids.  The  pharmacopreial  solution  does 
not  coagulate  albuminous  tissues,  and  like  oxalic  and  tartaric  acid  only 
coagulates  egg-albumen  after  addition  of  chloride  of  sodium  or  other  neu- 
tral salt. 

Circulatory  System. — The  effect  of  moderate  doses  of  phosphoric  acid 
is  stimulant,  but  of  large  doses,  especially  when  injected  into  the  blood- 
current,  depressant.  Two  cub.  centim.  of  a  four  per  cent,  solution  given 
to  a  frog,  increased  the  pulse-frequency,  and  the  direct  application  of  acid 
to  the  frog's  heart  at  first  strengthened  though  it  afterward  weakened 
the  contractions;  after  death,  the  heart-muscle  was  non-excitable  (Munk 
and  Leyden).  In  warm-blooded  animals,  after  the  subcutaneous  injection 
of  about  8  grammes,  slowness,  weakness,  and  irregularity  of  heart-beat 
occurred,  with  retarded  respiration,  lowered  temperature,  prostration,  and 
death  (Meyer). 

After  injections  of  phosphoric  acid  into  the  jugular  vein,  the  blood- 
pressure  and  the  pulse-frequency  are  lowered,  although  after  small  quan- 
"titiesthey  quickly  rise  again.  Pavy  found  that  he  could  inject  8  or  10 


DILUTE    PHOSPHORIC   ACID.  223 

dr.  of  the  pharmacopoeia!  solution  into  the  jugular  of  a  dog  without 
causing  death,  and  if,  in  any  animal,  the  maximum  amount  compatible 
With  life  was  injected,  the  urine  and  the  arterial  blood  became  highly 
charged  with  sugar  ("Guy's  Hospital  Reports,"  vol.  vii.,  1861).  We  may 
connect  this  result  with  the  fact  that  phosphoric  acid  acts  even  more 
powerfully  than  hydrochloric  in  diminishing  the  alkalinity  of  blood  (Wal- 
ter), while,  on  the  other  hand,  injections  of  soda  prevent  the  production 
of  artificial  diabetes;  but  the  full  bearing  of  such  facts  is  not  yet  known. 
Injections  of  acid  into  the  carotid  caused  primary  slowing  of  pulse  with 
secondary  quickening  before  death,  strong  inspiratory  cramp,  convulsions 
and  coma  (quoted  by  Husemann).  After  death  from  excessive  quanti- 
ties, ecchymoses  were  almost  always  found  in  the  lungs,  and  the  blood 
•was  altered,  being  dark  but  fluid,  and  not  easily  coagulable,  sometimes 
gelatinous.  The  effect  on  the  blood  is  not  always  the  same:  thus,  Pavy 
in  one  experiment  found  the  "  large  venous  trunks  in  the  liver  plugged 
with  coagulated  blood"  after  an  injection  of  30  dr.  of  acid  into  the  du- 
odenum; and  Gubler  says,  "introduced  into  the  veins  of  animals,  phos- 
phoric acid  coagulates  the  blood  and  causes  death  in  a  few  minutes:  "  this 
depends  on  the  dose  and  concentration.  Neumann  states  that  the  cor- 
puscles are  not  destroyed  by  the  acid,  but  may  be  much  altered  in  form 
and  vital  properties. 

The  action  upon  man  is  of  more  practical  interest,  but  very  few  in- 
vestigations have  been  made  with  phosphoric  acid.  Bobrick  records  a 
rise  of  the  pulse  from  70  to  90  beats  per  minute,  but  in  the  course  of  an 
hour  it  fell  to  66;  this  was  after  a  dose  of  $  oz.  A  rigor  also  occurred, 
the  cause  of  which  is  not  easy  to  trace,  but  it  was  followed  by  a  pleasant 
sensation  of  warmth.  Dr.  J.  B.  Andrews  (N.  Y.)  administered  doses  of 
from  1  to  3  dr.,  and  investigated  the  effect  by  means  of  sphygmograms 
taken  at  intervals  of  from  fifteen  minutes  to  one  hour.  He  says,  "  With- 
in the  first  interval  there  is  an  increase  in  the  force  of  the  pulsations, 
though  there  is  little  change  in  the  number  during  the  whole  time  of  ex- 
perimentation. The  increase  is  most  marked  after  the  lapse  of  from  one 
to  two  hours,  and  it  is  not  till  after  several  hours  that  the  pulse  returns 
to  its  normal  condition.  The  first  experiment  I  made  upon  myself,  be- 
ginning with  20  drops,  and  continuing  the  use  of  the  remedy  in  increased 
doses  till  the  amount  of  4  dr.  was  reached.  The  sensations  experienced 
from  40  min.  to  3  dr.  were  those  of  moderate  alcoholic  stimulation,  slight 
pain  through  the  frontal  region,  and  a  buoyancy  and  lightness  of  feeling 
rather  agreeable.  ...  In  the  pulse-traces,  additional  force  is  manifest  in 
the  heart's  action  in  all  cases,  and  in  the  general  appearance  of  weakly 
persons  placed  on  acid  treatment  the  same  fact  is  apparent — the  conges- 
tion of  the  extremities  and  lips  has  soon  given  place  to  a  more  natural 
color"  (American  Journal  of  Insanity,  October,  1869). 

Nervous  System. — Dr.  J.  B.  Andrews  and  many  others  find  phosphoric 


224  MATEKIA   MEDIC  A   AND   THEEAPEUTICS. 

acid  to  be  a  powerful  nerve-tonic,  hut  the  conclusions  are  founded  more 
upon  clinical  observations  on  depressed  persons  than  on  the  healthy. 
"  Moderate  doses  produced  on  the  latter  the  feeling  of  buoyancy  and  ex- 
hilaration already  mentioned,  but  larger  quantities  caused  a  feeling  of 
drowsiness,  an  inclination  to  lie  down,  and  unwillingness  for  mental  la- 
bor." The  acid  exerts  also  a  marked  control  over  the  vaso-motor  nerves,  and 
through  them  improves  the  tone  of  the  circulation.  Hecker  and  Burdach 
concluded  that  phosphoric  acid  acts  more  than  any  other  on  the  nervous 
system,  heightening  excitability  in  a  great  degree.  Sundelin  asserted 
that  this  action  is  directed  especially  to  the  genital  organs,  and  although 
neither  Neligan  nor  Andrews  could  verify  this,  I  have  myself  noted  it  in 
sixteen  patients,  who  had  no  knowledge  of  the  supposed  aphrodisiac 
quality  of  the  drug;  they  all  complained  to  me  of  such  effects  in  greater 
or  less  degree. 

Digestive  System. — Moderate  doses  tend  to  improve  the  tone  and 
functional  power  of  the  stomach,  and,  as  already  remarked,  this  acid  ir- 
ritates much  less,  even  after  continued  use,  than  the  other  inorganic  acids; 
large  or  concentrated  doses,  however,  taken  by  the  mouth,  may  cause  gas- 
tro-enteritis,  and  after  death,  redness,  erosion,  and  ecchymoses  have  been 
found  in  the  stomach  and  duodenum  (Monk  and  Leyden).  When  Pavy 
injected  1  to  2  oz.  into  the  stomach  of  dogs  it  was  quickly  rejected,  but 
on  passing  it  into  the  duodenum,  a  saccharine  condition  of  the  urine  and 
the  blood  was  produced,  just  as  after  intravenous  injections.  After  toxic 
doses,  fatty  degeneration  has  been  found  in  the  liver,  kidneys,  and  mus- 
cular tissue. 

SYNERGISTS  AND  ANTAGONISTS. — The  same  as  for  other  mineral  acids 
(v.  p.  196). 

THERAPEUTICAL  ACTION  (INTERNAL). — Nerve- Debility. — The  thera- 
peutical influence  of  phosphoric  acid  is  mainly  exerted  on  the  nervous 
system,  and  in  the  treatment  of  nerve-debility  acts  much  like  iron  in  anae- 
mia, as  a  chemical  food  supplying  something  actually  deficient  in  nerve-nu- 
trition. When  mental  effort  has  been  protracted  till  a  sense  of  weariness 
renders  its  continuance  difficult,  a  dose  of  the  acid,  from  its  stimulant 
effect,  relieves  fatigue,  and  seems  to  invigorate  the  mental  powers,  and 
prepare  the  mind  for  renewed  exertion. 

Dr.  J.  Andrews,  describing  a  case  of  impaired  mental  power  from  ex- 
cessive brain-activity,  observes,  "  The  patient  is  languid,  unable  to  do 
mental  work  with  the  usual  facility,  nervous,  and  at  times  fearful,  timid, 
and  agitated,  the  memory  weakened,  and  permanent  impairment  threat- 
ened. Such  cases  have  been  termed  '  cerebral  paresis,'  but  for  their  re- 
covery, relaxation  from  business,  and  phosphoric  acid,  with  some  suitable 
tonic,  generally  suffices." 

Of  more  serious  conditions,  such  as  dementia  following  acute  mania, 
Dr.  Andrews  remarks,  "  This  is  a  period  of  nervous  exhaustion,  of  reac- 


DILUTE   PHOSPHORIC    ACID.  225 

tion  from  the  increased  mental  and  physical  activity  -which  marked  the 
previous  state  of  the  disease;  tone  and  vigor  must  be  supplied  to  the 
prostrated  system,  and  for  this  phosphoric  acid  is  of  material  service."  It 
relieves  peripheral  congestions  connected  with  impaired  tone  of  vaso- 
motor  nerves,  and  in  weakened  relaxed  conditions  akin  to  impotence,  and 
resulting  from  sexual  excess,  it  has  proved  a  special  help. 

Fever. — In  any  fever  where  the  nervous  system  is  specially  depressed, 
phosphoric  acid  is  indicated;  it  assuages  thirst,  and  helps  to  remove  ex- 
haustion; its  pleasant  taste  is  one  advantage  over  the  other  mineral 
acids. 

Stromeyer,  and  others,  recommend  it  in  "eruptive  fevers."  The  fol- 
lowing is  a  convenient  form:  — 1£.  Acidi  phosphorici  diluti,  fl.  3  iij.;  gly- 
cerini,  fl.  3  j.;  decocti  hordei,  Oij. :  mix,  and  use  when  cold  as  a  common 
drink. 

Diabetes. — Phosphoric  acid  often  relieves  the  thirst  of  this  malady, 
and  has  been  recommended  by  Latham,  Paris,  Watson,  and  other  practi- 
cal physicians;  on  the  other  hand,  the  experiments  of  Pavy  (already 
quoted)  indicate  that  much  of  it  would  be  injurious,  and  Griesinger  not 
only  states  that  it  does  not  lessen  the  excretion  of  sugar,  but  in  one  case 
supposes  it  actually  to  have  caused  the  malady. 

Against  this,  we  might  set  a  case  recorded  by  Thornley,  in  which  the 
thirst  was  relieved  and  the  patient  apparently  cured  (Medical  Press,  May 
20, 1868);  but,  without  being  in  a  position  to  dogmatize  on  the  matter,  I 
may  say  that  I  have  known  the  acid  on  several  occasions  to  relieve  symp- 
toms and  diminish  the  amount  of  sugar  in  the  urine. 

Urinary  Disorder. — In  phosphatic  deposits  connected  with  waste  of 
nervous  tissue,  and  in  alkalinity  of  urine  with  nerve-depression,  phos- 
phoric acid  is  very  useful,  and  it  has  relieved  the  symptoms  of  phosphatic 
calculus  and  urethro-vesical  catarrh,  when  nitric  and  hydrochloric  acids 
had  failed.  Benefit  has  also  been  derived  from  it  in  oxaluria. 

In  Rachitis,  the  milky  phosphatic  condition  of  urine  is  cleared  by  the 
acid,  though  Dr.  H.  Wood  considers  that  the  phosphates  act  better. 

Phthisis — Struma. — In  these  conditions  generally,  phosphoric  acid 
fulfils  many  indications  as  a  grateful  moderately  astringent  tonic;  it  re- 
lieves hoarseness  and  dry  irritating  cough  accompanied  by  pain  and 
laryngeal  soreness.  Dr.  Cotton  gave  it  to  twenty-five  patients  with 
chronic  uncomplicated  phthisis  at  Brompton  Hospital,  and  observed 
benefit  in  a  few  advanced  cases:  it  improved  appetite  and  controlled  se- 
cretion, although  sometimes  nausea  and  pain  were  excited:  he  could  not 
trace  a  specific  effect  from  it,  but  rather  the  action  of  a  general  nerve- 
tonic;  it  acted  specially  well  combined  with  iron  (Medical  Times,  i., 
1863).  Dr.  C.  J.  B.  Williams  recommends  it  with  cod-liver  oil  (Lancet, 
ii.,  1868,  p.  213). 

In  the  dyspepsia  so  common  in  phthisis,  it  is  also  useful^  relieving  the 
VOL.  I.— 15 


226  MATERIA    MEDICA    AND    THERAPEUTICS. 

pain,  sickness,  and  diarrhoea  which  occur  after  meals.  Profuse  night- 
sweats  and  other  exhausting  discharges  are  controlled  by  it,  and  it  exerts 
a  sedative  effect  upon  the  excessive  sexual  desire  which  often  developes 
in  some  stages  of  phthisis.  Dr.  Todd  used  it  in  cardialgia. 

Haemoptysis — Hemorrhage. — M.  Hoffman  has  written  to  specially  re- 
commend this  acid  in  haemoptysis;  and  the  main  reasons  for  his  prefer- 
ence of  it  would  seem  to  be  its  "  less  corrosive  action,"  and  better 
toleration  by  the  stomach,  otherwise  its  stimulant  powers  would  make  it 
less  generally  suitable  than  sulphuric  acid;  he  gives  10  to  30  drops  in 
mucilage  (Journal  de  Chim.  Medic.,  June,  1868).  I  have  myself  seen 
good  results  from  the  acid  in  purpura  and  passive  hemorrhage,  also  in 
metrorrhagia. 

Strumous  Conjunctivitis. — This  malady  is  often  troublesome,  not  so 
much  from  its  severity,  as  from  its  persistence  and  great  tendency  to  re- 
lapse, and  Mr.  Balman,  has  written  to  praise  phosphoric  acid,  not  only  in 
struma,  but  especially  "  in  the  intermittent  ophthalmia  of  a  scrofulous 
constitution":  he  says  that,  given  in  doses  of  from  5  to  20  min.  in  cal- 
umba,  the  acid  both  cures  and  prevents  recurrence  of  the  affection  (Lon- 
don Medical  Gazette,  August  22,  1858). 

Scorbutus. — Liebig  and  others  have  held  that  the  scurvy  of  sailors  is 
mainly  owing  to  the  exclusion  of  phosphoric  acid  from  their  diet,  since 
in  the  ordinary  preparation  of  meat  for  sea-stores  the  greater  portion  of 
the  acid  is  extracted  from  it,  and  the  complaint  has  been  cured  by  giving 
food  containing  the  acid,  although  the  sailors  continued  to  use  the  salted 
beef  to  which  scurvy  was  attributed  ("  Letters  on  Chemistry,"  p.  425). 
Professor  Galloway  has  verified  the  presence  of  phosphoric  acid  in  lemon- 
juice,  and  hence,  according  to  Morgan  and  Neligan,  its  superiority  to 
citric  or  tartaric  acids,  but  I  am  not  aware  that  the  theory  has  been  largely 
tested  in  practice. 

Bone  Diseases — Caries. — In  caries,  M.  Leutin  applied  dilute  phos- 
phoric acid  to  the  affected  bone  with  the  idea  of  supplying  a  deficient 
element,  and  practically  this  sometimes  relieves  and  improves  the  bone- 
condition.  Its  good  effect  is,  however,  better  seen  from  internal  adminis- 
tration, especially  if  much  hectic  be  present.  It  is  said  to  be  also  bene- 
ficial in  cases  of  unusual  depositions  of  phosphate  of  lime,  as  in  exostosis, 
and  bony  tumors  generally  (Neligan,  Garrod).  Wormald  states  that  the 
detection  of  phosphoric  acid  in  pus  is  diagnostic  of  necrosis  (Lancet,  ii., 
1862,  p.  440). 

In  Rachitis  I  have  found  it  a  useful  medicine,  and  it  relieves  the  diar- 
rhoea and  sweating  of  that  disorder. 

Diarrhoea. — Phosphoric  acid  is  suitable  for  cases  of  diarrhoea  when 
an  acid  is  indicated.  Sedgwick  strongly  recommends  it  for  choleraic 
cases,  and  argues  for  its  use  in  true  cholera  (Lancet,  ii.,  1871,  p. 
280). 


SULPHURIC   ACID.  227 

PREPARATION  AND  DOSE. — Acidum  phosphoricum  dilutum  :  dose,  10 
to  30  min.  freely  diluted. 

[PREPARATIONS,  U.  S.  P. — Acidum  phosphoricum  dilutum,  sp.  gr. 
1.056.  Acidum  phosphoricum  glaciale — used  in  preparations.] 


ACIDUM  SULPHURICUM- SULPHURIC  ACID— OIL  OF 
VITRIOL,  H,S04,=98. 

This  occurs  native  in  the  water  near  volcanoes,  as  in  Java,  and  in  the 
"  Sour  Springs,"  in  the  town  of  Byron,  Genesee  County,  N.  Y.  It  is 
found  in  combination  in  twenty-two  natural  sulphates,  also  with  am- 
monium in  rain-water,  near  towns.  It  contains  79  per  cent,  of  anhyd- 
rous sulphuric  acid,  SO,. 

There  are  two  other  forms  of  the  same  acid,  the  acidum  sulphuricum 
dilutum,  and  the  acidum  sulphuricum  aromaticum,  which  are  weaker  by 
one-seventh  than  the  first-mentioned. 

PREPARATION. — By  passing  sulphurous  acid  gas  (sulphurous  anhyd- 
ride) into  leaden  chambers,  and  bringing  it  there  into  contact  with  steam 
and  nitrous  fumes  (nitrous  anhydride);,  from  the  latter  it  absorbs  an  atom 
of  oxygen,  becoming  sulphuric  acid  (anhydrous),  and  this  combines  with 
water  to  form  a  dilute  sulphuric  acid,  which  is  afterward  concentrated  up  to 
a  sp.  gr.  of  1.843;  a  small  quantity  of  nitric  oxide  gas  will  act  as  a  carrier 
of  oxygen  from  the  atmosphere  to  a  large  quantity  of  sulphurous  acid. 
In  chemical  formulae  the  main  reaction  may  be  represented  as  follows: — 
SO,  4-  H,0  +  N,03 = HSS04  +  2NO. 

CHARACTERS  AND  TESTS. — The  pure  acid  is  an  oily-looking,  colorless 
liquid,  but  the  commercial  acid  is  often  dark-colored  from  contained  frag- 
ments of  organic  matter,  which  are  charred  by  the  acid.  It  has  an  ener- 
getic affinity  for  water,  which  it  absorbs  readily,  so  that  a  partially-filled 
bottle  of  acid,  if  exposed  to  the  air,  will,  after  a  time,  overflow;  if  quickly 
mixed  with  water  it  undergoes  condensation,  and  much  heat  is  evolved. 
A  very  small  quantity  of  sulphuric  acid,  or  of  any  soluble  sulphate,  can 
be  detected  by  adding  to  the  diluted  solution  a  little  chloride  of  barium, 
which  gives  a  dense  white  precipitate,  insoluble  in  acids. 

ABSORPTION  AND  ELIMINATION. — Moderate  doses  of  the  dilute  acid 
are  readily  absorbed,  either  as  sulph-albuminates  (Orfila),  or,  after  com- 
bining with  bases  in  the  gastric  secretion,  as  sulphate  of  potash  or  soda 
(Miguel):  very  small  doses  only  in  the  latter  form  (Husemann). 

The  dilute  acid  forms  with  albumen  both  a  soluble,  and  an  insoluble 
compound  according  to  the  degree  of  dilution — the  former  resulting  from 
quite  weak  acid  (Berzelius).  That  dilute  sulphuric  acid  may  be  absorbed 
through  the  skin,  follows  from  the  experiments  of  Lebkuchner,  who  in- 


228  MATERIA   MEDIC  A    AND    THERAPEUTICS. 

duced  acid  reaction  of  urine  and  faeces  by  applications  to  the  abdomen 
of  rabbits. 

Gubler  teaches  that  this,  like  the  other  mineral  acids,  circulates  in 
the  blood,  but  loosely  combined  with  albumen,  and  that  on  reaching  the 
emunctories  the  combination  breaks  up,  albumen  remaining  in  the  vessels, 
while  the  acid  passes  out  with  the  excretions,  combining  with  the  bases 
therein  found. 

It  has  been  a  question  whether  after  poisonous  doses,  the  acid  may 
be  absorbed  and  remain  free  in  the  blood,  leading  to  its  coagulation. 
Geoghegan  states  that  after  1£  oz.,  when  a  woman  survived  thirty-one 
hours,  he  found  traces  of  acid  in  the  pericardium  and  in  the  kidney,  not 
in  the  blood,  but  in  that  fluid  he  found  much  phosphoric  acid,  derived,  he 
suggested,  from  phosphate  of  soda  from  which  sulphuric  acid  had  dis- 
placed it  (Medical  Gazette,  xl.).  In  another  case  Dr.  Walker  found  a 
trace  in  the  cerebral  fluid  and  in  the  cardiac  blood  (Edinburgh  Journal, 
1850).  Casper  found  the  blood  and  serous  fluids  acid,  and  Carus  states 
that  he  found  sulphuric  acid  in  all  the  organs  of  a  foetus,  after  a  fatal 
dose  taken  by  the  mother  ("Beck's  Jurisprudence,"  ii.,  p.  429).  More 
recent  researches  state  that  mineral  acids  cannot  be  detected  free  in  the 
blood,  and  that  its  reaction  cannot  be  rendered  acid  consistently  with  life 
(F.  Walter;  v.  Hydrochloric  Acid).  It  is  not  likely  that  the  coagula  de- 
scribed by  Bouchardat  in  the  great  vessels  were  really  due  to  direct  ac- 
tion of  free  acid, — Taylor  could  find  no  trace  of  it  in  similar  coagula  ("  On 
Poisons,"  p.  31). 

The  acid  is  eliminated  by  the  urine,  and  according  to  Dr.  Letheby, 
very  quickly  after  full  doses  (Medical  Gazette,  xxxix.,  p.  116).  Most  ob- 
servers agree  that  it  cannot  be  found  free  in  that  secretion,  but  as  sul- 
phate (Bence  Jones),  and  the  heightened  acidity  is  really  due  to  uric  and 
lactic  acids  displaced  by  the  stronger  sulphuric  acid  from  their  ordinary 
combinations.  Seeing  the  comparatively  small  amount  of  sulphuric  acid 
accounted  for  in  the  renal  secretion,  Headland  suggested  that  some  passed 
by  the  lower  bowel  and  the  skin,  and  this  is  probable. 

PHYSIOLOGICAL  ACTION  (EXTERNAL). — The  dilute  acid,  applied  to  the 
skin,  causes  some  burning  pain  and  pallor,  followed  by  redness;  more 
concentrated,  it  destroys  the  epithelium,  changing  it  into  a  firm  brown 
mass.  It  coagulates  albumen,  and  disintegrates  horny  tissues  with  for- 
mation of  leucin  and  tyrosin.  In  its  full  strength,  it  causes  destruction 
and  sloughing  of  any  tissue  by  virtue  of  its  strong  affinity  for  organic 
bases,  as  well  as  for  the  water  with  which  they  are  combined.  The  acid 
has  disinfectant  and  antiseptic  powers,  and  destroys  infusorial  life. 

PHYSIOLOGICAL  ACTION  (INTERNAL). — Digestive  System. — Very  small 
doses  give  a  characteristic  markedly  acid  taste,  and  lessen  the  sensation 
of  thirst;  10  to  15  min.  of  the  dilute  acid,  administered  several  times  at 
intervals,  stimulate  the  appetite  and  exert  some  astringent  effect  on  the 


SULPHURIC   ACID.  229 

gastric  and  other  secretions.  If  continued,  however,  the  medicine  induces 
dyspepsia  with  acid  eructation;  colic,  and  even  diarrhoea,  which  may  be 
due  to  the  large  amount  of  alkaline  sulphates  formed,  as  well  as  to  direct 
irritation. 

The  local  symptoms  induced  by  toxic  doses  of  the  strong  acid  are  very 
severe;  intensely  acid  pungent  taste  is  followed  by  acute  burning  pain 
in  the  mouth,  pharynx,  and  stomach,  and  violent  retching  and  vomiting 
the  ejecta  usually  containing  dark  blood;  there  is  extreme  thirst  and 
great  sense  of  distress — sometimes  purging  with  tenesmus.  The  faucial 
inflammation  may  induce  suffocation,  angina,  or  laryngeal  oedema,  and 
thus  prove  fatal  early  in  the  case,  or  peritonitis  may  be  set  up,  and  if 
death  do  not  occur  from  collapse,  it  may  follow  on  perforation  of  the 
oesophagus,  stomach,  or  bowel  in  twelve  to  forty-eight  hours  after  the 
poisonous  dose;  should  life  be  saved  for  the  time,  the  inflammation  of 
the  alimentary-tract  is  likely  to  be  followed  by  serious  contraction,  etc. — 
swellings,  and  suppuration  of  the  parotid  glands  may  occur.  Any  slough 
produced  by  this  acid  is  black  in  color. 

Circulatory  /System. — Bobrick  found,  with  frogs,  that  this  acid,  given 
by  the  stomach,  or  applied  to  the  skin,  caused  the  heart  to  act  more 
slowly,  and  finally  stopped  it  in  diastole.  Hertwig,  experimenting  on 
mammalia,  found  that  moderate  doses  of  the  dilute  acid  lowered  the 
pulse-rate  and  the  temperature,  while  arterial  tension  was  increased.  I 
am  not  aware  that  similar  results  have  been  verified  on  the  healthy  hu- 
man subject,  nor  has  proof  been  given  of  the  acid's  power  to  lower  tem- 
perature in  febrile  conditions.  It  has  been  said  by  some  that  the  blood 
becomes  less,  by  others  more,  coagulable,  but  its  exact  state  is  not  ascer- 
tained; nor  do  we  rightly  know  whether  the  smaller  vessels  are  con- 
tracted or  not  by  the  acid  (Nothnagel;  v.  p.  228).  When  injected  into 
the  veins  it  causes  instant  death  from  coagulation  of  blood  and  thrombo- 
sis, and  the  corpuscles  are  altered  or  destroyed  by  toxic  doses  taken  in- 
ternally. 

In  cases  of  poisoning  by  the  acid,  the  disturbance  of  circulation  is 
mainly  secondary  to  the  gastric  irritation:  there  may  be  faintings,  pass- 
ing on  to  actual  syncope  or  collapse,  the  pulse  becoming  later  rapid  and 
small,  the  extremities  icy  cold,  and  respiration  labored  and  superficial. 

Nervous  System. — Ordinary  doses  do  not  produce  other  than  tonic 
effects  upon  this  system.  In  fatal  cases  of  poisoning,  the  mind  is  gener- 
erally  clear  or  but  slightly  clouded;  exceptionally,  coma  has  developed. 

Glandular  System. — Most  of  the  secretions  become  more  acid  under 
the  free  use  of  this  drug,  and  some  of  them,  especially  those  of  the  skin 
and  the  bowel,  are  lessened  in  amount.  Bobrick,  however,  found  the 
quantity  of  urine  and  the  amount  of  urinary  sulphates  increased  by  it. 
After  large  doses,  Leyden  and  Munk  distinguished  different  conditions 
corresponding  to  different  alterations  in  the  kidney;  finding  albumen 


MATERIA    MEDICA    AND    THERAPEUTICS. 

alone,  or  with  epithelial  casts,  or  with  fatty  globules  and  epithelium,  or 
in  addition,  hyaline  casts,  and  blood-  and  pus-corpuscles. 

PATHOLOGICAL  CHANGES. — The  anatomical  lesions  found  in  the  stom- 
ach after  death  vary  according  to  the  concentration  of  the  acid,  and 
the  duration  of  its  effects.  In  milder  cases,  the  epithelial  and  the  upper 
layer  of  the  rete  mucosum  are  shrunk,  parchment-like  and  greyish:  in 
the  severest,  the  whole  tissue  is  mortified,  blackened,  and  changed  into  a 
soft  gangrenous  mass.  Fatty  degeneration  of  different  organs  has  also 
been  lately  described  as  a  constant  result  of  poisoning  by  sulphuric  acid, 
and  particularly  in  the  liver,  the  striped  muscular  tissue,  the  heart,  and 
the  renal  epithelium.  This  change  is  to  some  extent  explained  by  the 
destructive  action  on  the  red  corpuscles,  which  are  in  part  destroyed,  and 
in  part  altered,  becoming  smaller,  darker,  and  of  granular  appearance, 
and  certainly  unequal  to  their  proper  function;  hence  the  tissues  are  im- 
perfectly nourished,  and  readily  degenerate.  The  same  alteration  in  the 
oxygen-carriers  explains  the  lowered  temperature,  the  feeble  pulse,  and 
the  general  debility,  as  well  as  the  functional  albuminuria  from  excretion 
of  constituents  of  the  altered  blood-cells. 

SYNERGISTS. — The  other  acids  and  cooling  remedies  are  allied  in  ac- 
tion, and,  as  regards  styptic  effects,  ergot  and  astringents  generally  are 
auxiliaries. 

ANTAGONISTS  —  INCOMPATIBLES. — Warm  stimulating  remedies  and 
"  fluidifying  "  medicines,  such  as  mercury  and  iodides,  antagonize  some  of 
the  effects  of  sulphuric  acid.  Alkalies  and  bases  are  chemically  incom- 
patible. The  best  antidotes  in  a  case  of  poisoning  are  magnesia,  chalk 
or  white-wash,  and  soap,  which  should  be  given  in  albuminous  solutions, 
such  as  milk  and  water.  Alkaline  carbonates  are  considered  not  advis- 
able because  they  form  irritant  compounds  (Christison);  also  they  evolve 
much  carbonic  acid,  but  may  be  used  in  cases  of  emergency.  Oil  to  pro- 
tect the  mucous  membrane  of  the  stomach  is  also  very  useful. 

THERAPEUTICAL  ACTION  (EXTERNAL). — The  highly  caustic  property 
of  strong  sulphuric  acid  is  utilized  comparatively  seldom  on  account  of 
the  difficulty  of  restraining  it  within  due  limits. 

Chancre — Gangrene — Cancer. — In  chancre,  with  phagedaenic  ulcer- 
ation,  Ricord  recommends  a  caustic  paste  made  with  sulphuric  acid  and 
charcoal  to  be  applied  on  linen  for  several  hours — until  a  slough  forms. 
In  hospital  gangrene  the  pure  acid  has  been  successfully  employed 
(Medical  Times,  i.,  1859).  For  such  purposes  and  for  cancer,  Sir  J. 
Simpson  mixed  it  with  zinc  sulphate.  The  reason  for  using  powders,  es- 
pecially charcoal,  to  mix  with  the  acid,  is  to  secure  a  full  strength  in  con- 
venient form  without  dilution  with  water:  Syme  employed  sawdust;  Vel- 
peau,  saffron. 

Caries — Necrosis. — It  is  evident  that  a  lotion  containing  mineral  acid 
will  dissolve  out  the  earthy  bases  of  bone-tissue  and  quicken  disintegra- 


SULPHURIC    ACID.  231 

tion,  and  for  this  purpose  it  has  been  applied  to  some  extent  in  surgery. 
Chassaignac  recommended  dilute  hydrochloric  acid,  but  more  recently 
Mr.  Pollock  has  brought  forward  much  evidence  in  favor  of  the  applica- 
tion of  sulphuric  acid  mixed  with  an  equal  part  of  water,  "  for  the  more 
speedy  removal  of  dying  bone,  or  more  rapid  separation  of  dead  portions, 
or  destruction  of  the  surface  of  carious  cavities; "  he  finds  it  simple  and 
safe,  and  comparatively  painless — nor  has  he  ever  seen  bad  consequences 
from  it.  His  first  case,  one  of  necrosis  of  cranial  bone,  was  touched  daily 
with  the  dilute  acid, — the  diseased  part  quickly  separated,  and  healthy 
granulations  formed.  Cavities  may  be  filled  with  lint  soaked  in  acid,  and, 
when  this  is  removed,  in  two  or  three  days  an  opaque  white  layer  may  be 
seen  and  taken  away;  this  is  a  slough,  soft  owing  to  removal  of  earthy 
particles,  which  may  be  found  lying  loose  in  the  wound:  any  pain  caused 
by  the  caustic  ceases  in  a  short  time  because  the  acid  is  soon  neutral- 
ized. In  some  flat  bones,  such  as  those  of  the  trunk  or  pelvis,  the  undi- 
luted acid  may  be  cautiously  used.  Recovery  may  be  secured  "  in  weeks 
instead  of  months  "  under  such  treatment,  though  it  will  not  always  suc- 
ceed without  operative  interference  (Lancet,  i.,  1870).  W.  Hayward, 
H.  Marsh,  and  others,  have  also  recorded  good  results  from  the  practice 
recommended  by  Mr.  Pollock. 

Ectropion — Entropion. — In  these  deformities  of  the  eyelids,  sulphuric 
acid  has  been  used  by  Laurence  to  cause  a  linear  cicatrix,  which,  by  its 
contraction,  shall  restore  the  natural  position  of  parts,  but  other  methods 
of  cure  are  preferable. 

Poisoned  Wounds. — This,  like  the  other  mineral  acids,  when  em- 
ployed to  cauterize  poisoned  wounds,  bites,  etc.,  has  the  advantage  over 
solid  caustic  of  more  penetrating  power.  W.  Frazer  considered  strong 
sulphuric  acid  better  than  any  other  ("  Materia  Medica,"  p.  12). 

Parasitic  Skin  Diseases. — In  ringworm  and  in  scabies,  an  ointment 
containing  1  dr.  of  acid  to  the  oz.  of  lard  has  sometimes  proved  useful, 
though  irritating;  for  the  latter  malady  it  is  said  to  be  largely  used  in 
the  Prussian  army  (Neligan). 

Pruritus. — In  prurigo,  lichen,  and  chronic  urticaria,  disorders  attended 
with  violent  itching,  a  lotion  containing  1  to  3  dr.  of  dilute  acid  in  8  oz. 
of  water  often  relieves.  Pereira  says  that  its  internal  administration  is 
also  efficacious. 

Angina.  For  relaxed  surfaces  coated  with  tenacious  mucus  dilute 
sulphuric  acid  is  an  excellent  cleansing  astringent:  hence  it  is  inconstant 
use  as  a  gargle  (1  to  2  dr.  in  8  oz.  of  infusion  of  roses)  for  relaxed  uvula, 
etc.;  in  weaker  proportion  it  is  also  suitable  for  scarlatinal  throat.  The 
addition  of  2  dr.  of  alum  to  the  gargle  often  greatly  increases  its  value. 

THERAPEUTICAL  ACTION  (INTERNAL).—  It  is  commonly  said  that  for 
digestive  disorders  requiring  an  acid,  hydrochloric  is  the  best:  to  stimu- 
late hepatic  and  intestinal  secretion  nitric  acid  is  indicated,  while  the  as- 


232  MATERIA    MEDIC  A    AND    THERAPEUTICS. 

tringent  effect  of  sulphuric  is  of  special  value  in  controlling  sanguineous 
and  other  discharges. 

Hemorrhage. — Sulphuric  acid  was  formerly  in  very  frequent  use  as  an 
internal  remedy  for  hemorrhage,  especially  of  passive  character,  whether 
from  the  stomach,  lungs,  or  uterus.  That  there  is  difficulty  in  explain- 
ing how  it  can  exercise  astringent  effect  after  dilution  and  possibly  com- 
bination in  the  blood,  would  be  no  argument  against  its  use  if  this  were 
proved  efficacious;  but  my  experience  is  the  same  as  that  of  many  modern 
observers  (among  whom  I  may  mention  Nothnagel  and  H.  C.  Wood),  who 
give  to  sulphuric  acid  a  secondary  place  among  haemostatics,  although  I 
have  known  it  succeed  sometimes  when  other  remedies  have  failed. 

Diarrhoea. — Dilute  sulphuric  acid  has  a  well-deserved  reputation  in 
various  forms  of  intestinal  flux,  and  especially  in  summer  diarrhoea  of 
choleraic  character:  it  often  answers  well,  but  when  given  alone  I  have 
sometimes  found  it  aggravate  the  disorder,  whether  by  irritation  or  by 
increasing  the  acidity  of  secretions:  the  aromatic  sulphuric  acid  should 
then  be  preferred  in  combination  with  some  preparation  of  opium. 

In  diarrhoea,  with  coated  tongue  and  evidence  of  biliary  disorder,  the 
acid  has  acted  admirably  with  small  doses  of  magnes.  sulph.,  tinct.  rhei., 
and  aqua  chloroformi:  it  is  a  good  remedy  for  children. 

Cholera. — Dr.  Curtin  has  recorded  that  a  severe  epidemic  in  an  insti- 
tution under  his  direction  ceased  within  twelve  hours  after  the  inmates 
were  treated  freely  with  "sulphuric  acid  lemonade" — the  only  fresh  case 
occurring  in  a  man  who  refused  to  take  the  medicine.  Two  days  after  it 
was  discontinued  two  new  cases  appeared,  and  an  epidemic  threatened, 
but  was  again  stayed  by  the  acid,  and  in  the  surgical  wards,  where  the 
acid  was  used  from  the  first,  no  case  appeared,  while  every  other  part  of 
the  institution  suffered  more  or  less  (Philadelphia  Medical  Times,  iii.,  p. 
649).  This  experience  makes  it  desirable  under  similar  circumstances  to 
adopt  the  same  method  as  prophylactic. 

Fever. — In  the  diarrhoea  of  enteric  fever,  H.  Kennedy,  Murchison, 
and  other  authorities  advocate  the  use  of  sulphuric  acid  (v.  p.  197).  We 
do  not  expect  from  it,  as  formerly,  a  power  of  shortening  the  morbid  pro- 
cess; but  it  will  allay  thirst,  and,  to  some  extent,  moderate  the  pyrexia 
and  the  undue  secretion.  In  any  enteric  cases,  the  dose  used  should  be 
small  and  well  diluted:  the  aromatic,  I  find  preferable  to  the  simple  form. 

Pyrexia — Phthisis. — Whether  sulphuric  acid  does  or  does  not  lower 
pulse  and  temperature  in  the  usually  employed  doses,  it  certainly  is  of 
more  service  in  secondary  pyrexial  states  than  in  specific  fever.  In  sub- 
acute  inflammatory  conditions  of  protracted  character  occurring,  e.g.,  dur- 
ing caseous  pneumonia  or  chronic  phthisis,  it  alleviates  the  general  symp- 
toms, and  sometimes  the  local  conditions.  It  is  well  suited  for  phthisical 
cases  with  a  tendency  to  undue  discharges,  for  it  acts  as  a  grateful  tonic 
and  astringent,  lessening  the  night-perspirations,  the  intestinal  flux,  the 


SULPHUROUS    ACID.  233 

expectoration,  and  passive  haemoptysis;  by  combination  with  opium,  or 
belladonna,  aromatics,  etc.,  so  much  relief  may  be  sometimes  given  as  to 
merit  for  the  remedy  its  old  title  of  "  Elixir  Vitriol." 

The  presence  of  cough  does  not  contra-indicate  its  use,  but  irritation 
'of  the  fauces  must  be  obviated  by  mucilage  or  syrup:  acids  should,  how- 
ever, be  omitted  if  gastric  irritation  be  excited  bv  them. 

Palpitation. — Nothnagel  recommends  ,this  acid,  combined  with  laxa- 
tives, in  the  palpitation  of  plethoric  subjects;  it  is  not  indicated  for  the 
anaemic  or  chlorotic,  nor  specially  useful  in  the  palpitation  of  valve  dis- 
ease. 

Lead  Poisoning. — Since  the  publication  of  the  cases  of  M.  Gendrin  and 
Dr.  H.  Bennett  in  1846,  the  acid  has  had  more  or  less  reputation  as  an 
antidote  and  prophylactic  in  poisoning  by  lead;  but  modern  observation 
does  not  quite  corroborate  their  estimate  of  it.  Tanquerel  especially 
failed  to  obtain  any  good  results  ("Maladies  de  Plomb,"  ii.,  p.  497);  on 
the  contrary,  the  use  of  an  acid  lemonade  seemed  to  make  the  workmen 
rather  more  liable  to  colic. 

PREPARATIONS  AND  DOSE. — Acidum  sulphuricum — Oil  of  vitriol:  is 
not  used  internally  except  in  the  following: — Acidum  sulphuricum  aro- 
maticum  :  dose,  5  to  30  min.  freely  diluted.  Acidum  sulphuricum  dilu- 
tum  :  dose,  5  to  30  min.  freely  diluted.  An  alkaline  mouth-wash  should 
be  used  after  taking  the  acid,  or  a  little  butter  placed  on  the  teeth  before. 

ADULTERATIONS. — The  usual  impurities  of  this  acid  are  salts,  nitrous 
oxides,  arsenic,  and  lead. 


ACIDUM  SULPHUEOSUM— SULPHTJKOUS  ACID,  SO2,  =  64. 

The  pharmacopoaial  sulphurous  acid  is  a  solution  of  the  gas  in  water, 
containing  9.2  per  cent,  by  weight  =: twenty  times  its  volume. 

PREPARATION. — By  deoxidizing  sulphuric  acid  by  distilling  it  with 
coarsely-powdered  wood  charcoal.  The  carbon  combines  with  part  of 
the  oxygen  of  .the  acid  to  form  carbonic  acid  and  probably  carbonic  oxide, 
while  sulphurous  acid  gas  (anhydrous)  passes  over  into  a  receiver  con- 
taining distilled  water,  being  previously  washed  from  sulphuric  acid  and 
other  impurities. 

2C+HaSO4=COa+2H3O+2SO, 

CHARACTERS  AND  TESTS. — A  nearly  saturated  solution  of  sulphurous 
anhydride,  SO,,  colorless,  of  strong  suffocating  odor  and  pungent  acid 
taste,  which,  however,  is  not  unpleasant  in  moderate  dilution.  It  bleaches 
vegetable  colors,  and  is  an  energetic  oxidizing  agent:  it  is  said  to  ab- 
sorb radiant  heat  in  a  high  degree  (R.  Bird).  The  hydrated  acid  can  be 
obtained  in  crystals  but  is  very  unstable.  A  solution  of  the  officinal 


234  MATEEIA    MEDIC  A   AND    THERAPEUTICS. 

strength  and  upward  oxidizes  on  exposure  to  light  and  air  (e.g.,  when 
kept  in  partially-filled  transparent  bottles),  with  formation  of  sulphuric 
acid — an  important  change,  since  the  special  properties  of  the  drug  are 
thereby  impaired  or  lost;  contact  with  chlorine  at  once  induces  this 
change.  It  should  therefore  be  carefully  kept;  or  better  still,  be  freshly 
prepared  when  wanted.  Water  would  absorb  forty  or  fifty  times  its  bulk, 
alcohol  still  more;  but  Professor  Redwood  recommends  a  5  per  cent,  so- 
lution, as  more  easily  made  and  more  stable  than  that  of  the  British 
Pharmacopoeia. 

Tests. — 1.  When  evaporated,  it  should  leave  no  residue.  2.  Barium 
chloride  gives  a  copious  white  precipitate  (of  barium  sulphate)  if  sul- 
phuric acid  be  present.  3.  Sulphurous  acid  decolorises  a  solution  of  iodine 
with  formation  of  hydriodic  and  sulphuric  acids,  thus — 

SO,+2H,O+I,=H,SO4+mL 
3.2  gr.  sulphurous  acid  neutralize  12.7  iodine. 

Of  the  gas,  1  part  in  100,000  of  air  is  perceptible  to  the  nose;  9  parts 
are  disagreeable  and  provoke  cough ;  20  parts  are  irritating,  and  43  parts 
(=4  parts  in  10,000)  are  irrespirable:  much  less  than  this  will  kill  plants 
(Letheby,  loc.  cit.).  In  generating  it  by  burning  sulphur  in  air,  32  parts 
by  weight  combine  with  an  equal  quantity  of  oxygen  to  produce  64  parts 
of  sulphurous  anhydride,  which  occupy  precisely  the  same  bulk  as  the 
oxygen  consumed.  Its  density  is  high,  the  sp.  gr.  being  2.247;  a  cubic 
foot  weighs  about  1,206  gr.,  and  to  produce  it  603  gr.  of  sulphur  and  a 
cubic  foot  of  oxygen  (=5  cubic  feet  of  atmospheric  air)  are  requisite 
(Letheby:  Medical  Times,  ii.,  1873). 

Alkaline  sulphites  and  hyposulphites  owe  their  properties  to  the  sul- 
phurous acid  liberated  from  them,  and  although  not  officinal  are  often 
prescribed. 

Sodce  Sulphis — Sulphite  of  Soda. — Prepared  by  saturating  a  solution 
of  carbonate  of  soda  with  sulphurous  acid  gas,  and  crystallizing.  It  oc- 
curs in  white  efflorescent  prisms  which  have  a  slight  alkaline  reaction,  and 
the  odor  and  taste  of  sulphurous  acid  ;  soluble  in  cold  water  (1  part  in  4), 
and  in  less  than  1  part  boiling  water. 

Sodce  Hyposulphis — Hyposulphite  of  Soda  (Appendix  B.  P.). — Pre- 
pared by  gently  warming  a  solution  of  sulphite  of  sodium  with  finely- 
powdered  sulphur,  or  by  passing  sulphurous  acid  gas  through  it.  Occurs 
in  colorless  crystals  (oblique  rhombic  prisms);  bitter,  slightly  alkaline, 
and  sulphurous  in  taste,  less  unpleasant  than  the  sulphite.  Very  soluble 
in  water,  not  in  alcohol;  decolorises  iodine  solutions,  and  dissolves  salts 
of  silver  which  are  commonly  insoluble,  e.g.,  the  chloride.  A  solution  of 
hyposulphite  is  distinguished  from  one  of  sulphite  by  the  precipitation 
of  sulphur  on  adding  sulphuric  acid.  Hyposulphites  do  not  act  on 
iodide  of  potassium. 

Potasses,  Sulphis — Sulphite  of  Potash. — Prepared  by  saturating  a  so- 


SULPHUROUS   ACID.  235 

lution  of  potash  carbonate  with  sulphurous  acid  gas,  and  crystallizing1. 
It  occurs  in  white  opaque  fragments  or  powder,  with  slight  odor  of  the 
gas — very  soluble  in  water  (1  in  3).  Taste  saline  and  sulphurous. 

Magnesioe  Sulphis — Sulphite  of  Magnesia. — Contains  proportionately 
more  of  the  acid  (gas)  than  any  other;  it  is  also  the  most  soluble,  and 
the  least  unpleasant  (Polli). 

Golds  Sulphis — Sulphite  of  Lime. — Is  soluble  only  in  800  parts  wa- 
ter, but  the  bisulphite  and  hyposulphite  are  freely  soluble. 

ABSORPTION  AND  ELIMINATION. — Sulphurous  acid  is  readily  absorbed, 
and  its  characteristic  odor  has  been  observed  in  the  breath  and  secretions 
after  its  administration  (Dr.  George  Wilks:  British  Medical  Journal,  ii., 
1870).  It  passes  out  also  with  the  urine  and  fseces  as  sulphate  or  sul- 
phuric acid,  for  it  is  readily  oxidized  in  the  system. 

The  sulphites  are  decomposed  in  the  stomach  by  the  gastric  acid,  sul- 
phurous acid  is  given  off,  and  they  are  mostly  changed  into  sulphates 
(Kletzinsky),  and  are  eliminated  as  such,  partly  by  the  intestinal  canal, 
but  chiefly  by  the  kidneys  (Bartholow);  they  pass  within  twelve  to  twen- 
ty-four hours  after  administration  (Polli). 

The  hyposulphites  undergo  similar  changes,  but  more  slowly,  for  they 
are  more  stable. 

After  very  large  doses,  these  salts  may  be  found  unchanged  in  the 
urine  (Rabuteau),  and,  after  their  application  to  wounds,  free  sulphuric 
acid  may  be  traced  in  the  same  secretion  (De  Ricci). 

PHYSIOLOGICAL  ACTION  (EXTKBNAL). — Externally  applied,  sulphurous 
acid  is  refrigerant,  somewhat  astringent,  and  in  full  strength  irritant. 
The  most  important  property  of  the  gas  and  its  compounds  is  that  of  ar- 
resting fermentation,  and  of  destroying  the  lower  forms  of  vegetable  and 
animal  life,  and  certain  infective  organic  poisons.  Its  power  of  controll- 
ing ferments  and  destroying  visible  parasites  is  readily  proved,  but  its 
action  on  infectious  organic  particles — a  true  "  disinfectant "  action,  by 
which  they  are  rendered  inert — is  not  so  capable  of  demonstration,  because 
the  poison  itself,  the  essence  of  infection,  has  not  yet  been  verified  and 
isolated;  still,  as  Dr.  Sansom  observes,  "we  know  that  such  poison  is 
ponderable,  that  it  obeys  physical  laws,  and  is  active  for  long  periods, 
though  so  minutely  divided  as  to  be  undemonstrable  by  ordinary  direct 
physical  means  "  (British  Medical  Journal,  ii.,  1872).  The  diffusion-ex- 
periments of  Chauveau  and  Sanderson  have  proved,  at  least  for  vaccinia, 
variola,  and  sheep-pock,  that  the  poison  is  solid,  insoluble, -and  indiffusi- 
ble;  and,  to  judge  from  its  effects,  its  extraordinary  power  of  multiplica- 
tion, etc.,  either  it  must  have  some  properties  of  living  matter,  or  act  by 
a  process  of  catalysis  or  fermentation :  the  former  seems  more  likely,  but 
however  it  be,  if  we  make  evident  that  sulphurous  acid  can  prevent  or 
arrest  the  development  of  the  bacteria,  monads,  and  germs  of  fungi,  etc., 
which  accompany  decomposition,  it  is  by  analogy  probable  that  it  can 


236  MATERIA    MED1CA    AND    THERAPEUTICS. 

exert  a  similar  effect  on  the  minuter  particles  which  constitute  infective 
poison.  In  proof  of  the  former  fact,  among  other  experiments,  Dr.  San- 
som  placed  cubes  of  egg-albumen  under  glass  covers  with  solutions  of 
permanganate,  of  aluminium  chloride,  of  carbolic  and  sulphurous  acids; 
and,  with  the  two  latter  agents,  notably  with  the  last,  secured  almost 
complete  preservation,  even  after  the  admission  of  air  (British  Medical 
Journal,  loc.  cit.).  For  aerial  disinfection,  Hoppe-Seyler,  after  careful 
trial,  found  sulphurous  acid  gas  the  best  agent, — 1  or  2  per  cent,  of  it  in 
the  air  of  a  room  destroying  all  the  lower  organisms:  this  could  be  secured 
by  burning  •£  to  1  dr.  of  sulphur  for  each  100  cubic  feet  of  space  (Lancet, 
ii.,  1871,  p.  304). 

Letheby  arrived  at  similar  conclusions,  but  recommended,  for  greater 
security,  a  larger  proportion  of  sulphur — 1£  oz. — to  each  100  cubic  feet 
of  air  (Medical  Times,  ii.,  1873). 

Dr.  Baxter,  taking  up  the  same  question  from  another  point  of  view, 
concluded  not  only  that  sulphurous  acid  was  the  best  of  aerial  disinfect- 
ants, but  that  its  action  on  vaccine  virus  was  more  potent  than  that  of 
chlorine  or  carbolic  acid.  Thus  he  vaccinated  one  arm  of  a  child  with 
points  of  virgin  lymph,  and  the  other  arm  with  points  previously  exposed 
to  the  action  of  the  three  agents,  and  while  small  vesicles  often  resulted 
after  the  use  of  chlorine  or  carbolic  acid,  none  could  be  obtained  after 
sulphurous  acid,  "even  under  conditions  which  seemed  to  render  the  vir- 
ulent particles  least  susceptible  to  destructive  influences  "  ("  Sixth  Report 
of  Medical  Officer  Privy  Council,"  N.  S.,  and  Lancet,  i.,  1876).  It  is  true 
that  Dr.  Dougall  had  found  sulphurous  not  so  effective  as  other  mineral 
acids  (notably  chromic  acid)  in  preventing  the  decomposition  of  organic 
solutions,  but  Grace  Calvert  showed  this  was  not  correct,  and  1  part  of 
the  former  in  1,000  of  albuminous  solution  was  enough  to  preserve  it  for 
forty  days,  while  other  acids  only  preserved  it  for  nine  or  ten  days.  Dr. 
Fergus  also  compared  glasses  of  beef  extract  heated  with  sulphurous  acid, 
carbolic  acid,  and  terebene,  and  found  several  weeks  afterward  that  the 
one  heated  with  sulphurous  acid  remained  quite  sweet  while  the  others 
were  decomposed  (Practitioner,  i.,  1877). 

PHYSIOLOGICAL  ACTION  (INTERNAL). — From  the  preceding  and  many 
other  observations,  there  can  be  no  doubt  of  the  disinfectant  power  pos- 
sessed by  sulphurous  acid  in  a  very  high  degree  when  brought  into  direct 
contact  with  infective  or  putrescent  material,  whether  in  the  air,  or  in 
wounds,  etc.,  but  the  further  question  whether  it  can  be  so  introduced  in- 
to the  circulating  blood  of  living  animals  as  to  neutralize  a  septic  poison 
therein  also  circulating,  or  so  as  to  prevent  the  admission  of  such  poison, 
is  more  difficult  to  resolve.  Dr.  Polli  (Milan)  held  the  affirmative  to  be 
proved  by  his  experiments  upon  dogs  with  sulphites  and  hyposulphites;  f 
after  treating  an  animal  with  these  medicines,  he  injected  septic  poison, 
and  found  it  did  not  succumb  to  the  effects,  while  a  healthy  but  untreated 


SULPHUROUS    ACID.  237 

animal  quickly  did  so.  In  other  cases,  examining  the  bodies  of  animals 
killed  after  sulphite  treatment,  they  were  found  to  decompose  much  less 
quickly  and  less  readily  than  others  not  so  treated.  He  offered,  also, 
some  clinical  evidence  of  the  value  of  these  remedies  in  septicaemia,  and 
much  practical  benefit  was  expected  from  his  observations;  they  have 
not,  however,  yet  passed  the  region  of  controversy.  Semmola,  O.  Weber, 
and  others,  deny  them,  or  characterize  them  as  "  negative."  Clinical  re- 
sults differ,  and  although  I  hold  that  much  may  be  done  by  introducing 
"disinfectant"  medicines,  especially  sulphurous  acid,  into  the  organism, 
I  acknowledge  that  definite  proofs  of  their  power  and  mode  of  action 
within  it  are  still  to  be  desired  (v.  p.  243,  also  Carbolic. and  Salicylic 
Acids). 

Digestive  System. — Sulphurous  acid  solution  may  be  taken  internally 
in  moderate  doses  and  well  diluted  without  definite  effects  on  the  healthy 
body,  unless  it  be  the  quenching  of  thirst  and  some  refrigerant  action. 
Insufficiently  diluted,  the  solution  excites  local  irritation  of  the  digestive 
tract,  some  persons  being  more  sensitive  to  this  than  others.  The  sul- 
phites and  hyposulphites  in  large  doses  increase  peristalsis,  and  cause 
purging,  though  not  so  readily  as  sulphates. 

Temperature. — Given  during  the  pyrexial  state,  e.g.,  of  remittent 
fever,  sulphurous  acid  is  said  to  lower  the  body-temperature. 

SYNEKGISTS. — Disinfectants  and  antiseptics  generally,  aid  the  action 
of  sulphurous  acid,  but  it  is  so  readily  oxidized  that  it  is  better  used 
alone.  Steam  favors  the  aseptic  action  of  the  gas,  and  nitre  added  to  the 
burning  sulphur  makes  it  more  effective  (Dewar). 

ANTAGONISTS. — All  oxidizing  substances  alter  the  chemical  constitu- 
tion of  sulphurous  acid,  and  impair  the  peculiar  properties  of  sulphites, 
especially  when  in  solution.  The  mineral  acids,  including  sulphuric,  de- 
compose sulphites  and  hyposulphites. 

THERAPEUTICAL  ACTION  (EXTERNAL) .  —  Parasitic  Skin  Disease — 
Favus — Ringworm. — Sulphurous  acid  solution  is  a  cleanly  and  efficient 
mode  of  treating  these  maladies,  as  first  pointed  out  by  Sir  William  Jen- 
ner  (Medical  Times,  ii.,  1853,  p.  181).  It  may  be  painted  on  occasionally 
in  full  strength,  or  used  in  lotion  or  compress,  1  part  to  2  or  4  of  water 
and  glycerin — the  great  point  is  to  secure  its  thorough  contact  with 
the  diseased  surface. 

Pityriasis  Versicolor  ( Chloasma). — A  weaker  lotion  than  the  last- 
mentioned,  1  part  in  8,  or  one  containing  sulphite  or  hyposulphite  of  soda 
(  1  j-  in  §  v"j-)  w^  cure  ^is  disorder. 

Pruritus  Vulvce,  etc. — When  pruritus  is  dependent  on  discharge,  or 
other  source  of  irritation,  possibly  parasitic,  injections  and  lotions  con- 
taining "  bisulphite  of  soda  "  (gr.  xv.  ad  §  j.)  have  been  found  serviceable 
(Lancet,  ii.,  1871,  p.  454).  The  itching  of  lichen  and  of  true  prurigo 
senilis  may  also  be  relieved  by  lotions  containing  sulphites. 


238  MATERIA    MEDICA    AND    THERAPEUTICS. 

Erysipelas. — A  sulphurous  lotion  will  often  give  great  relief  to  the 
burning  pain  of  erysipelas,  and  its  constant  application  is  said  to  cut 
short  the  malady.  Dr.  Hewson  records  twenty-seven  cases  of  various 
degrees  of  severity — seven  of  them  idiopathic,  and  all  treated  by  the  local 
ase  of  a  sulphite  lotion  (sodse  sulphitis  gr.  x.  ad  3  j.)  applied  on  lint 
covered  with  oiled  silk;  it  bleaches  the  skin  and  "  destroys  the  inflamma- 
tion "  (Philadelphia  Medical  Times,  i.,  1868).  Mr.  Pairman  describes 
great  and  immediate  relief  to  pain  in  a  severe  case  of  facial  erysipelas 
from  a  lotion  of  equal  parts  of  glycerin  and  sulphurous  acid:  the  patient 
recovered  at  the  end  of  a  week,  but  tincture  of  steel  and  other  remedies 
were  given  internally;  relief,  however,  was  clearly  traceable  to  the  lotion, 
and  it  deserves  to  be  more  generally  used  than  it  is  at  present. 

Chilblains —  Corns — Fissured  Nipples,  etc. — For  these  minor,  but  an- 
noying ailments,  sulphurous  acid  is  a  good  remedy.  Mr.  Pairman  applies 
the  strong  solution  of  the  acid  on  lint  covered  with  oiled  silk:  if  the 
skin  be  broken,  the  acid  should  be  diluted.  Sore  nipples  are  to  be 
"soaked  well  with  strong  acid  for  a  few  times"  (Pamphlet:  "The  Great 
Sulphur  Cure,"  13th  ed.,  1868).  Mr.  Fergus  applies  the  acid  in  spray  to 
chilblains,  or  uses  as  a  wash  3  parts  of  the  solution  to  1  of  glycerin  and  1 
•of  water  (Lancet,  ii.,  1870,  p.  769). 

Bruises — Sprains. — The  same  surgeon,  who  speaks  from  good  expe- 
rience at  Marlborough  College,  has  found  a  lotion  containing  sulphurous 
acid  very  useful  in  "  every  kind  of  bruise  and  sprain."  He  recommends 
a  spray  of  pure  acid  for  six  or  seven  minutes  till  the  part  feels  cold,  then 
lotion  (1  in  8)  to  be  applied  and  frequently  changed;  in  forty-eight  hours 
inflammation  and  pain  have  subsided,  and  on  the  third  or  fourth  day  the 
limb  can  be  strapped  or  bandaged. 

Wounds — Fractures. — Mr.  Fergus  records  also  excellent  results  from 
the  acid  used  in  lotion  to  a  compound  fracture  and  to  a  severe  contused 
wound  of  the  face  (where  it  is  always  important  to  avoid  scarring):  under 
a  lotion  of  1  part  in  7  constantly  applied,  the  wounds  healed  quickly  and 
without  suppuration.  Dr.  John  Balfour  has  had  marked  success  with  a 
lotion  (1  in  12)  applied  on  thin  rag  kept  constantly  wet  for  the  first  day 
or  two  after  injury,  afterward  wetted  every  twelve  hours  with  tepid 
lotion  kept  covered  by  oiled  silk,  zinc  ointment  being  substituted  about 
the  third  or  fourth  day.  Severe  compound  fractures  of  the  hand  with 
laceration  of  tendon,  and  gunpowder  burns,  fractures  of  the  shoulder  and 
other  joints  by  machinery — all  did  well  under  this  treatment,  which 
seemed  to  give  almost  instant  relief  from  pain,  to  control  and  greatly  re- 
strain suppurative  action,  and  secure  primary  union  whenever  possible. 
(Edinburgh  Medical  Journal,  June,  1869,  November,  1871).  Mr.  Pair- 
man notes  its  value  in  quickly  curing  a  "  hack  "  in  horses. 

Ulceration — Gangrene. — In  cases  of  unhealthy  open  wounds,  and 
even  hospital  gangrene,  sulphurous  acid  has  sometimes  proved  more 


SULPHUROUS   ACID.  239 

efficacious  than  carbolic;  this  was  especially  seen  in  hospitals  at  Metz 
during  the  Franco-Prussian  war  (Medical  Times,  ii.,  1871,  p.  358). 

Angina. — In  various  forms  of  sore  throat,  sulphurous  acid  in  gargle, 
or  preferably  in  fine  spray,  is  exceedingly  useful,  relieving  pain,  lessening 
inflammation,  destroying  parasitic  growth,  and  cleansing  unhealthy  sup- 
purating surfaces.  It  is,  in  my  experience,  of  great  value  in  aphthous 
conditions  such  as  occur  during  phthisis  or  other  exhausting  diseases,  as 
well  as  in  the  ordinary  form  common  during  infancy;  it  often  relieves 
the  pain,  tension,  and  ulceration  of  scarlatinal  and  variolous  throats,  and 
I  have  seen  it  of  the  greatest  service  in  chronic  syphilitic  ulceration  of 
the  fauces. 

In  the  acute  inflammatory  stage  of  catarrhal  angina,  it  is  not  always  well 
borne,  but  will  be  found  to  answer  better  in  such  cases  when  used  of  full 
strength,  if  only  for  a  very  short  time,  than  if  diluted;  in  the  latter  case, 
it  has  seemed  to  irritate  the  mucous  membrane  without  controlling  in- 
flammation, but  there  is  no  one  rule,  a  short  trial  will  be  the  best  guide; 
young  children  do  not  usually  bear  it  well.  Fergus,  on  the  other  hand, 
says  it  is  good  "in  all  forms  of  inflammation  of  the  throat  and  tonsil;" 
it  should  change  the  turgid  redness  to  a  light  pink  during  the  applica- 
tion. 

Dysphonia  Clericorum — Follicular  Pharyngitis. — Dr.  Dewar  has  pub- 
lished cures  of  this  condition,  so  rapid  and  after  so  many  years'  duration 
of  the  malady,  as  to  border  on  the  marvellous.  One  clergyman,  a  sufferer 
for  twenty  years,  found  immediate  relief  from  the  spray — "  something 
loose,  feeling  braced  up;"  and  others  suffering  also  from  general  weak- 
ness, night-sweats,  nervousness,  partial  aphonia,  etc.,  are  said  to  have 
been  restored  by  sulphur  fumes  and  spray.  The  cases  are  described  in 
popular  language  rather  than  with  scientific  accuracy,  but  we  may  accept 
the  fact  of  much  relief  being  afforded  in  the  class  of  maladies  referred  to 
(Medical  Times,  i.,  1867,  p.  545). 

Catarrh — Hay  Fever. — A  sulphurous  acid  spray  applied  to  the  nos- 
trils often  relieves  the  annoying  symptoms  of  both  these  maladies.  Sul- 
phur-fumigation is  also  said  to 'have  cured  them  quickly  (Dewar,  Pair- 
man),  but  this  cannot  always  be  depended  upon  (McGregor:  Edinburgh 
Medical  Journal,  October,  1869). 

Chronic  Bronchitis. — The  spray  is  sometimes  a  useful  adjunct  in  the 
treatment  of  this  condition;  it  acts  as  a  stimulating  expectorant,  thin- 
ning the  tough  viscid  phlegm;  sulphur-fumigation  is  also  good  (Fergus). 
It  will  not,  however,  accomplish  the  wonders  at  one  time  expected  from 
it,  and  should  be  commenced  cautiously. 

Asthma. — In  this  capricious  malady,  sulphurous  sprays  and  fumiga- 
tions have  been  tried,  and  apparently  with  advantage,  but  more  often 
with  marked  increase  of  irritation;  as  a  rule,  other  remedies  relieve  more. 

Phthisis. — Dr.  Dewar  has  recorded  a  remarkable  case  in  the  person  of 


240  MATERIA    MEDICA    AKD    THERAPEUTICS. 

a  groom  advanced  in  phthisis,  with  emaciation,  cough,  sweatings,  haemop- 
tysis, etc.,  and  apparently  in  a  hopeless  condition,  who  conducted  sul- 
phur-fumigations for  cattle  (y.  p.  242),  remaining  with  them  in  the  sheds 
"with  the  most  wonderful  benefit  to  his  own  health:  within  one  week 
the  night-sweats  had  ceased,  his  cough  abated,  and  expectoration  dimin- 
ished; he  gained  weight — nearly  two  stone  in  four  months:  is  now  de- 
pendent for  his  life  on  one  lung  only,  or  nearly  so,  but  with  the  exception 
of  being  somewhat  short-winded,  looks  nearly  as  strong  and  as  able  for 
ordinary  work  as  before  his  illness"  (Pamphlet:  "  On  the  Application  of 
Sulphurous  Acid  Gas,"  1866).  He  reports  four  other  cases  of  "  chronic 
phthisis"  equally  benefited;  and  Mr.  Pairman  corroborates  his  observa- 
tions; they  deserve  careful  consideration,  but  up  to  the  present  there  has 
been  little  further  trial  of  the  method. 

It  was  thought  that  the  sulphurous  spray  would  be  of  great  service 
in  the  relief  of  phthisical  symptoms,  but  I  have  not  seen  lasting  or  im- 
portant results  from  it,  though  it  facilitates  expectoration  and  lessens 
laryngeal  irritation. 

Fumigation  in  Infectious  Disease,  etc. — The  burning  of  sulphur  for 
the  prevention  or  cure  of  infectious  disorder  long  preceded  any  modern 
scientific  inquiry.  The  Chinese  esteemed  it  highly  in  prehistoric  times. 
Ulysses,  according  to  Homer,  employed  it  to  disinfect  his  palace  after 
slaughtering  the  suitors,  calling  it  "  the  remedy  of  all  evils,  and  cure  of 
all  sores  "  ("  Odyssey,"  Book  xxii.,  line  481,  etc.).  Ovid  praises  it  in  the 
"  Fasti,"  and  Pliny  in  his  "  Natural  History;  "  but  it  is  within  quite  recent 
years,  and  since  the  recognition  of  a  "  germ  theory  "  in  disease,  that  the 
systematic  use  of  sulphurous  acid,  within,  as  well  as  without,  has  been 
placed  upon  a  logical  basis  or  fairly  pressed  upon  the  profession  as  a 
method  of  treatment. 

When  cattle  plague  was  epidemic,  Dr.  Dewar  found  the  best  results 
from  fumigating  cattle  sheds  with  sulphurous  acid.  His  own  cattle  never 
suffered,  and  "  a  large  dairy,  notorious  for  thirty  years  for  mortality 
among  its  cows  (from  pleuro-pneumonia),  and  which  for  eight  years  of 
the  then  tenant's  occupancy  had  never  been  free  from  disease  for  a 
month,  in  which  sixteen  cows  had  lately  died,  the  last,  three  days  before 
fumigation  began;  this  dairy  from  that  time  till  the  date  of  writing  had 
been  perfectly  healthy."  He  states  also  that  "an  epidemic  of  diphtheria 
was  cut  short  by  it;  two  cases  having  occurred  in  one  house  within 
twenty-four  hours,  and  no  others  after  sulphur-fumigations."  Mr.  Pair- 
man reports  similar  experience,  but  it  must  be  said  that  neither  author, 
however  earnest  and  truthful  in  reality,  writes  in  such  a  manner  as  to 
convince  the  profession,  and  hence,  perhaps,  they  have  not  yet  widely  in- 
fluenced ordinary  practice. 

The  variola  epidemic,  arrested  on  the  coast  of  Iceland  by  Dr.  Hjalte- 
lin,  seems  to  me  admissible  evidence  of  the  value  of  the  gas,  though  even 


SULPHUROUS   ACID.  241 

•"s, 

this  arrest  has  by  some  been  attributed  to  the  quarantine  and  isolation 
enforced.  Twenty-two  cases  were  brought  on  shore  from  the  fishino- 
vessels;  seven  were  confluent;  only  one  died  (moribund  on  admission); 
in  no  instance  did  the  disease  spread.  A  workman  emploved  in  the  hos- 
pital did  not  catch  small-pox,  although  shortly  after  he  proved  suscepti- 
ble to  vaccination;  in  every  case  the  attack  was  quickly  and  favorably 
modified:  results  which  may  fairly  be  connected  with  the  treatment — 
constant  use  of  sulphur  fumes  in  the  air,  and  the  giving  of  sulphurous  so- 
lution internally  (British  Medical  Journal,  ii.,  1871).  (An  epidemic  of 
small-pox  in  the  last  century — 1707 — destroyed  one-fourth  of  the  popula- 
tion of  the  same  country). 

Dr.  A.  W.  Foote,  during  the  last  epidemic  of  variola  in  Dublin,  en- 
deavored to  carry  out  a  thorough  disinfectant  treatment  in  his  wards  at 
the  Meath  Hospital,  giving  sulpho-carbolates  as  well  as  sulphurous  acid, 
applying  the  latter  locally,  and  burning  sulphur  three  or  four  times  a  day; 
he  treated  59  cases,  of  which  24  were  confluent,  6  semi-confluent,  and  11 
died,  and  he  concluded  that  the  treatment  was  of  value,  and  that  sul- 
phur vapor  acted  "  as  a  prophylactic,"  but  was  irritating  to  bronchitic 
subjects.  This  fact  is  important,  for  in  confluent  small-pox,  laryngitis  is 
a  frequent  and  serious  complication  (Dublin  Journal  and  Medical  Times, 
April,  1872). 

On  the  other  hand,  we  have  to  note  unsatisfactory  results  from  the 
use  of  similar  treatment  during  an  epidemic  at  Trinidad.  Dr.  Bakewell, 
though  riot  furnishing  many  details,  states  that  he  treated  twenty-five 
patients  with  sulphur-fumigations  and  sulphurous  acid,  apparently  "  with- 
out any  effect "  (  Medical  Times,  L,  1872). 

The  experience  of »Mr.  Fergus  as  to  disinfection  after  an  epidemic  of 
scarlatina  is  very  favorable:  upwards  of  4,000  blankets  and  other  articles 
of  infected  bedding  and  clothing  were  exposed  thoroughly  for  four  hours 
to  the  fumes  of  burning  sulphur,  "with  complete  success"  (Practitioner, 
i.,  1877).  He  is  accustomed  to  depend  on  a  short  personal  exposure  to 
sulphur  fumes  after  visiting  an  infectious  case,  and  has  never  conveyed 
infection  in  his  own  person.  He  lays  stress  upon  an  important  point,  in- 
attention to  which  might  possibly  account  for  some  failure:  the  vapor 
should  be  used  at  intervals  for  half  to  one  hour  at  a  time,  and  at  its  full 
strength,  rather  than  by  being  constantly  given  off  at  low  tension — the 
latter  method  is  apt  to  be  ineffective,  as  well  as  more  likely  to  give  rise 
to  unpleasant  sulphur  combinations. 

The  acid  bleaches  vegetable  colors,  and  corrodes  metals,  etc.,  but  not 
so  markedly  as  to  cause  inconvenience  in  practice.  The  pernicious  effect 
on  human  air-passages,  formerly  attributed  by  high  authorities  to  effect- 
ive sulphur  vapor  has  been  quite  disproved.  Dr.  Angus  Smith  says, 
"This  acid  gas  is  an  irritant,  and  causes  coughing,  which  becomes  painful 
and  dangerous  according  to  the  amount  used,  and  as  it  is  destructive  to 
VOL.  I.— 16 


242  MATEKIA    MEDICA    AND    THEKAPEUTICS. 

animal  structures  it  does  not  seem  advisable  to  use  it  more  than  can  be 
avoided"  (On  Disinfectants):  such  an  opinion  lias  doubtless  told  against 
its  use,  but  after  the  observations  of  Dewar,  Pairman,  Fergus,  and  others, 
must  now  be  modified. 

Cholera. — The  burning  of  sulphur  fires  round  infected  villages  has 
been  strongly  urged  (Tuson:  Lancet,  ii.,  1876,  p.  313). 

Mode  of  fumigating  with  Sulphurous  Acid  Gas. — Dr.  Dewar,  refer- 
ring more  particularly  to  the  process  as  applied  for  cattle  plague,  recom- 
mends as  the  safest  and  most  convenient  apparatus,  "  a  chaffer  two-thirds 
full  of  red  cinders,  a  crucible  inserted  therein,  and  a  piece  of  sulphur 
stick  " — "a  piece  "  the  length  of  a  man's  thumb  will  burn  for  twenty  min- 
utes and  be  sufficient  for  a  shed  containing  six  cattle,  and  if  ventilation 
be  free  at  the  same  time,  a  man  can  remain  without  the  least  risk  of  de- 
triment— this  is  repeated  three  or  four  times  daily.  Its  efficacy  is  in- 
creased by  simltaneous  steam-fumigation,  and  if  only  "  inanimate  ob- 
jects "  are  to  be  disinfected,  nitre  may  be  added  to  the  sulphur,  and  thus 
some  sulphuric  acid  generated  (Pamphlet,  pp.  7-21). 

For  phthisical  and  other  patients,  the  room  is  simply  filled  with  fumes 
three  times  a  day.  Mr.  Pairman  places  half  a  teaspoonful  of  sulphur  on 
paper  on  a  shovel  and  ignites,  repeating  this  process  every  twenty  min- 
utes till  the  patient  has  had  one  or  two  hours  of  fumigation; — the  head 
should  not  be  held  too  near,  nor  the  furnes  made  so  strong  as  to  excite 
much  coughing.  He  is  in  favor  of  keeping  "  mild  sulphur  fumes  almost 
constantly  in  the  sick  room,"  but  the  occasional  and  temporary  use  of  a 
full  dose  is  to  be  preferred.  Dr.  A.  W.  Foote  "  used  "  flowers  of  sulphur 
dropped  on  a  heated  shovel,  and  carried  about  the  room,  and  this  is  quite 
under  control  and  readily  borne  by  patients  unless  «bronchitis  or  asthma 
renders  them  unusually  sensitive.  From  1  to  2  dr.  will  be  an  average 
quantity:  it  is  scarcely  necessary  to  make  an  exact  calculation. 

If  a  room  is  to  be  thoroughly  disinfected  in  the  absence  of  inmates,  the 
doors,  windows,  and  other  apertures  should  be  closed — pasting  paper  over 
chinks  is  sufficient — colored  clothes  removed,  and  metal  protected  by 
grease  or  otherwise;  then  sulphur  should  be  burnt  in  quantity  propor- 
tioned to  the  space,  taking  Letheby's  estimate  of  1£  oz.  for  each  hundred 
cubic  feet,  or  more  roughly  the  proportion  of  |-  Ib.  for  a  large  room 
(Fergus).  If  dried  and  finely  powdered,  it  will  burn  when  lighted,  and 
may  be  conveniently  placed  in  a  small  earthern  jar  standing  in  water: 
mixed  with  -fa  part  of  its  weight  of  powdered  charcoal  it  burns,  perhaps, 
more  readily,  and  will  not  melt  and  run  over — the  charcoal  will  be  uncon- 
sumed  (Fergus).  If  this  mixture  be  placed  on  an  iron  plate  two  feet  square 
it  will  be  safe,  though  for  precaution  some  would  put  the  plate  or  vessel 
over  water.  After  an  hour's  fuming,  a  free  current  of  air  should  be  ad- 
mitted for  several  hours  before  occupying  the  room.  Mr.  Keates,  the 
chemist,  has  suggested  the  burning  of  bisulphide  of  carbon  as  a  conve- 


SULPHUROUS    ACID.  243 

nient  means  of  obtaining  gaseous  sulphurous  acid,  for  much  more  of  this 
gas  is  given  off  than  of  carbonic  acid — especially  is  this  the  case  if  petro- 
leum be  mixed  with  it.  In  a  room  of  1,300  cubic  feet}  280  gr.  bisulphide 
charged  the  air  so  efficiently  with  SO3  that  one  could  not  remain  in  it, 
and  a  lamp  has  been  contrived  to  burn  a  graduated  amount  (Lancet,  ii., 
1876,  p.  712).  It  is  said  too  that  the  offensive  smell  of  bisulphide  is  got 
rid  of  in  the  purer  preparations  (Price  &  Co.),  but  still  it  remains  highly 
inflammable,  and  the  method  seems  more  dangerous  and  more  complex 
than  simple  sulphur  burning. 

THERAPEUTICAL  ACTION  (!NTEBXAL). — Following  up  the  observations 
already  mentioned  as  to  the  effect  of  sulphites  upon  dogs,  Prof.  Polli  de- 
vised a  special  method  of  treating  "  zymotic  "  diseases— the  "  anti-fer- 
mentative, or  anti-zymotic  method,"  which  aimed  at  prophylaxis  by  sat- 
urating the  blood  with  these  remedies.  The  method  made  progr^s  in 
Italy,  Spain,  and  France,  not  much  in  Germany,  and  lately  it  has  lost 
ground  even  in  the  former  countries  (Nothnagel);  still  I  think  that  with 
modifications  it  has  a  future  before  it,  and  will  mark  a  distinct  advance 
in  rational  therapeutics.  It  is  applied  not  only  to  the  specific  fevers, 
cholera,  intermittents,  and  the  like,  but  also  to  pyaemia  and  septicsemia 
generally. 

Septicaemia. — Dr.  Polli,  Dr.  De  Ricci,  and  others,  have  recorded  cases 
of  pyaemia,  phthisis  with  suppuration,  chronic  empyema,  etc.,  benefited 
by  sulphites. 

Mr.  Spencer  Wells  traced  improvement  in  septicaemia  uterine  cases  to 
the  use  of  hyposulphites  (Medical  Times,  ii.,  1864). 

McCall  Anderson  cured  eruptions  of  furunculi  with  £-dr.  doses  of  sul- 
phite of  soda  (Lancet,  i.,  1870,  p.  897),  and  Dr.  Ricci,  chronic  pemphigus 
with  sulphite  of  magnesia  (Dublin  Journal,  vol.  xxxvi.).  Dr.  C.  B.  Rad- 
cliffe,  when  suggesting  the  use  of  the  same  salt  in  cattle  plague,  states 
that  he  has  seen  good  results  from  it  in  fevers  (Lancet,  i.,  1870,  p.  897). 

Snow  Beck  used  frequent  vaginal  injections  of  sulphite  of  soda  in 
puerperal  fever,  and  gave  internally  the  sulphites  of  lime  or  magnesia, 
and  advocated  this  treatment  as  better  than  any  other  (Lancet,  i.,  1865, 
p.  340).  Sulphite  of  soda  in  2-dr.  doses  daily  (readily  taken  in  beef-tea) 
proved  valuable  in  pyaamia  in  the  Liverpool  Infirmary  (Medical  Times, 
ii.,  1868,  p.  336),  and  Dr.  Miller,  while  reporting  the  hyposulphite  inef- 
fectual in  typhus,  found  it  distinctly  of  service  when  given  early  in  sep- 
ticsemic  cases  connected  with  parturition  (Edinburgh  Journal,  September, 
1869).  This  is  not  a  large  amount  of  evidence,  and,  though  more  might 
be  collected  from  foreign  sources,  it  would  not  be  enough  to  place  this 
medication  yet  on  an  assured  basis,  but  considering  how  serious  a  condi- 
tion is  in  question,  it  well  deserves  further  inquiry.  Of  course,  if  blood- 
poisoning  have  reached  beyond  a  certain  point,  recovery  is  not  possible 
under  any  treatment,  and  if  the  salts  employed  be  not  fresh  and  pure, 


244  MATERIA   MEDICA    AND    THERAPEUTICS. 

failure  also  will  result;  irritation  of  stomach  and  intestinal  tract  may  also 
hinder  their  employment,  and  I  think  that  sulphurous  acid  is  really  a  bet- 
ter form  to  employ  than  its  alkaline  compounds;  but  whichever  be  chosen 
should  be  early  and  thoroughly  given.  There  is  no  objection  to  combin- 
ing this  medication  with  the  internal  use  of  aconite,  and  with  all  recog- 
nized remedies  to  promote  elimination. 

Variola. — We  have  already  stated  that  in  the  hands  of.  Dr.  Hjaltelin 
and  Dr.  A.  W.  Foote,  the  internal  use  of  sulphurous  acid  solution  in  small- 
pox was  combined  with  the  external  application  of  the  gaseous  form,  and, 
so  far  as  could  be  judged,  with  good  effect.  The  secondary  fever  of  this 
malady  is  due  to  absorption  from  the  pustular  eruption,  and  this  ought  to 
be  influenced  by  the  early  employment  of  such  remedies,  and  I  believe  is 
so  influenced.  In  one  exceedingly  severe  case  of  confluent  small-pox, 
considered  hopeless  by  a  good  practitioner,  the  patient  was  enabled  to 
take  £-dr.  doses  of  sulphurous  acid  every  hour  or  two,  and  within  a  short 
time  showed  signs  of  improvement,  which  went  on  to  complete  recovery, 
not  in  accord  with  the  normal  rate  of  progress  in  such  cases.  To  vario- 
lous  pustules  maturating  the  acid  with  glycerin  is  a  good  application. 

Erysipelas. — The  relief  given  by  the  acid  spray  in  erysipelas  by  Dr. 
Hewson  and  Mr.  Pairman  has  been  already  noted,  but  the  internal  use 
of  the  remedy  may  be  well  conjoined  with  the  external.  In  the  case  of 
an  infant  living  under  unhealthy  conditions,  and  in  whom  a  severe  attack 
of  the  idiopathic  malady  affected  one  arm  and  leg,  the  pudenda  and  head, 
and  when  iron  had  no  control  over  it,  the  internal  use  of  sulphurous  acid 
seemed  the  cause  of  improvement  which  very  quickly  followed. 

Diphtheria. — Under  sulphur  it  has  been  stated  that  the  local  applica- 
tion of  that 'remedy  is  not  desirable  (v.  p.  30),  but  sulphurous  acid  acts 
very  much  better,  and  is,  as  a  rule,  well  borne,  and  even  liked  by  the 
patient. 

Dr.  Dewar  and  Mr.  Pairman  used  it  rather  in  fumes  and  spray  or  gar- 
gle, and  conjoined  with  it  iron  or  chlorate  of  potash.  Dr.  Joyce  (quoted 
by  Dr.  Geo.  Johnson,  Lancet,  i.,  1875,  p.  82)  had  the  best  results  from 
the  same  practice  (with  iron).  Fergus  depends  on  the  acid  with  ice 
only,  and  other  observers  have  had  satisfactory  results  from  the  salts: 
thus  Dr.  Hayden  from  the  hyposulphite  (Dublin  Quarterly,  August, 
1866).  I  think  the  local  application  of  the  acid  in  spray  highly  desirable. 

Enteric  Fever. — While  recognizing  the  difficulty  of  a  true  judgment 
about  the  effect  of  medicines  in  this  fever  on  account  of  some  uncertainty 
in  its  natural  course  and  duration,  and  of  the  usual  recoveries  indepen- 
dently of  any  specific  treatment,  yet  I  must  state  my  conviction  that  its 
course  may  be  favorably  influenced  by  the  internal  use  of  sulphurous 
acid,  if  commenced  early  enough.  I  know  that  many  of  the  highest 
authorities  have  taught  that  the  fever-poison  having  once  been  received 
must  pass  through  certain  changes  before  elimination,  and  that  the  best 


SULPHUROUS    ACID.  245 

practice  is  mainly, — intelligent  nursing;  but  careful  observation  of  many 
enteric  cases  has  led  me  to  the  conclusion  that  in  some  instances,  under 
the  influence  of  the  administration  of  sulphurous  acid  or  the  sulphites 
the  attack  has  been  shortened,  and  in  others,  high  temperature  and  pro- 
fuse diarrhoea  have  been  relieved,  coincidently  with  improvement  in  the 
general  symptoms.  In  some  advanced  cases,  with  muttering  delirium, 
sorcles,  and  signs  almost  of  dissolution,  a  favorable  change  has  occurred 
shortly  after  commencing  the  acid  treatment.  Of  thirty-six  consecutive 
cases  thus  treated  by  Dr.  Mackey,  several  illustrated  these  points,  and 
none  died.  Special  advantage  from  the  acid  is  not  claimed  on  the  score 
only  of  the  number  recovered,  for  equal  results  have  been  recorded  from 
other  methods:  the  number  is  still  too  small  to  justify  positive  conclu- 
sions, but  the  impression  made  on^  my  own  mind  as  to  the  value  of  the 
acid  is  highly  favorable. 

It  is  true  that  sometimes  unusual  or  persistent  vomiting  interferes 
with  its  administration,  and  the  drachm  or  two-drachm  doses  recom- 
mended cannot  always  be  given:  10  to  30  drops  has  been  an  average  dose 
for  an  adult,  when  repeated  every  two  to  four  hours,  and  when  urgent 
bronchitis  contra-indicates  this  remedy,  for  a  time  expectorants  and 
diaphoretics  must  be  substituted.  Several  years  ago,  Dr.  Hamilton 
(Liverpool),  treating  his  last  eight  cases  of  an  epidemic  of  typhoid  with 
sulphurous  acid,  "  was  struck  by  the  mild  form  assumed,  and  apparent  cut- 
ting short  of  the  fever."  They  were  typical  cases  at  the  commencement — 
five  children,  three  adults — and  the  dose  was  from  1  to  3  dr.;  they  were 
generally  better  on  the  second  day,  and  by  the  fifth  day  improvement  had 
set  in  (Lancet,  i.,  1869,  p.  45).  Dr.  George  Wilks,  of  Ashford,  refers  to 
171  cases  of  enteric  fever  treated  by  him  with  sulphurous  acid,  and  all  end- 
ing in  recovery,  some  under  very  unpromising  conditions;  thus  he  instances 
a  poverty-stricken  child  of  four  years,  with  violent  vomiting,  purging,  tym- 
panitis, and  delirium,  who  could  not  have  ordinary  care  and  attention;  a 
woman  of  seventy -three  equally  neglected;  and  a  man  of  fifty-four  ap- 
parently dying  under  ordinary  treatment  of  astringents,  etc.,  and  yet 
rapidly  recovering  after  commencement  of  the  acid  treatment  (British 
Medical  Journal,  ii.,  1870).  The  patients  took  from  2  to  20  drops  with 
syrup  and  water  every  four  hours  for  many  days,  until  they  showed  am- 
ple evidence  of  the  absorption  and  elimination  of  sulphur.  Dr.  Skinner 
reports  twenty  cases  of  enteric  fever  treated  by  sulpho-carbolate  of  soda 
(with  one  death). 

Dysenteric  Diarrhoea — Cholera. — Dr.  Scoffern  writes  recommending 
the  sulphite  of  lime  in  choleraic  diarrhoaa  (Lancet,  ii.,  1866,  p.  279),  but 
it  has  not  been  much  used.  On  the  hypothesis  of  cholera  being  dependent 
upon  the  absorption  of  organic  poison,  sulphurous  acid  ought  to  prove 
of  some  service  in  its  treatment,  more  so  than  the  sulphites  and  hyposul- 
phites, which  are  slower  in  action  and  liable  to  irritate.  Professor  Gra- 


246  MATEBIA    MEDICA    AND    THERAPEUTICS. 

ham,  indeed,  first  introduced  the  solution  of  sulphurous  acid  to  Sir  Wm. 
Jenner  as  a  possible  remedy  for  cholera,  but  it  has  never  received  full 
trial.  A  main  difficulty,  as  regards  any  remedy  in  cholera,  is  to  secure 
its  absorption,  all  vital  function  being  annihilated  with  such  fearful 
rapidity:  hence  we  can  never  hope  for  the  same  results  as  in  enteric 
fever,  but  sulphur  fumes  should  certainly  be  used  as  disinfectant  and 
prophylactic. 

It  has  been  pointed  out  that  workers  in  copper,  and  in  powder  fac- 
tories (at  Madras  especially),  have  shown  special  immunity  in  cholera 
epidemics,  and  although  Dr.  Burq  claims  specific  virtues  for  copper  in 
this  respect  (v.  Cuprum),  the  presence  of  sulphurous  acid  is  a  more  likely 
explanation  (Lancet,  ii.,  1873). 

Ague. — The  hypothesis  of  ague  being  dependent  upon  the  absorp- 
tion of  minute  fungi  or  spores  given  off  by  the  soil  of  malarious  districts 
has  been  forcibly  maintained  by  H.  Schmidt,  Salisbury,  and  others,  who 
have  even  reported  the  finding  of  such  microscopic  organisms  in  the  blood 
and  secretions  of  patients,  and  in  the  neighboring  marshes  (Lancet,  ii., 
1867,  p.  588).  Evidence  in  favor  of  this  theory  seems  furnished  by  such 
instances  as  that  of  the  ship  Argo,  which  took  on  board  for  (water  sup- 
ply to)  a  band  of  soldiers,  water  from  a  malarious  district,  and  almost  all 
who  drank  of  it  got  intermittent  fever,  while  the  sailors  of  the  same  ves- 
sel, who  had  a  different  water  supply,  did  not  suffer  (Lancet,  loc.  cit). 
Still,  the  hypothesis  is  not  proved,  and  clinical  evidence  as  to  the  value 
of  sulphite  treatment  is  contradictory — thus,  while  Sanger  refers  to  four 
cases  of  intractable  ague,  soon  relieved  and  ultimately  cured  by  scruple 
doses  of  hyposulphite  of  soda  (Lancet,  i.,  1869),  McClean  criticises  the 
result,  and  notes  that  quinine  and  other  remedies  had  been  previously 
used,  and  that  it  it  is  well-known  quinine  often  does  not  cure,  unless  a 
blood  depurant,  such  as  potash  or  soda  first  be  given,  and  moreover  many 
cases  in  the  Mauritius  were  treated  by  the  sulphites  without  effect,  and 
were  afterward  cured  by  quinine  (Lancet,  i.,  1869,  p.  511).  Several 
American  writers  have  reported  the  cure  of  intermittents  by  hyposul- 
phites after  failure  of  quinine  (Ranking,  Abstract,  ii.,  1868,  ii.,  1870), 
but  Farelli,  from  an  exhaustive  analysis  of  the  recorded  evidence,  con- 
cludes that  their  good  effect  is  neither  so  quick  nor  so  constant  as  that 
of  the  latter;  they  are  not  prophylactic,  and  their  continued  use  leads  to 
anaemia:  he  holds  that  their  action,  such  as  it  is,  "  is  reductive,  not  disin- 
fectant "  (Abstract,  Lancet,  i.,  1873,  p.  634). 

Syphilis. — Several  writers,  chiefly  American,  have  strongly  recom- 
mended the  internal  and  external  use  of  the  sulphites  in  the  later  stages 
of  syphilis  (Ranking,  ii.,  1868).  I  have  had  no  occasion  to  prescribe 
them,  but  have  found  the  acid  locally  applied  most  useful  in  throat  and 
other  ulcerations.  Dr.  Purdon  has  recorded  an  illustrative  case  (British 
Medical  Journal,  i.,  1868). 


TARTARIC    ACID.  247 

Pyrosis — Sarcinous  Vomiting. — In  these  conditions,  which  are  clearly 
dependent  more  or  less  upon  fermentations  or  the  presence  of  low  or- 
ganisms, the  influence  of  sulphurous  acid  and  its  compounds  ought,  d 
priori,  to  be  clearly  shown,  and  so  practically  \ve  find  it,  for  sulphurous 
acid  in  £-dr.  doses  is  one  of  the  best  remedies  that  can  be  given.  Sir 
William  Jenner  was  one  of  the  first  to  point  this  out  (Medical  Times,  ii., 
1853),  and  Dr.  Henry  Lawson,  one  of  the  first  to  secure  for  it  the  atten- 
tion of  the  profession  (Practitioner,  vol.  i.).  C.  Drysdale  also  early 
recorded  a  case  rapidly  relieved  by  this  treatment  after  failure  of  bismuth, 
prussic  acid,  etc.  (Lancet,  ii.,  1869).  Other  physicians  have  succeeded 
with  the  hyposulphites  (Medical  Times,  i.,  1853),  and  even  with  sulphites, 
and  if  Dr.  Lawson  found  no  benefit  from  these,  as  compared  with  the 
acid  itself,  it  was  probably  because  his  dose  was  but  small:  the  hyposul- 
phites, however,  must  deposit  sulphur,  and  as  a  rule,  the  acid  will  be 
found  best. 

PREPARATIONS  AND  DOSE. — Acidum  sulphurosum :  dose,  £  to  1  fl.  dr., 
diluted.  For  external  application  the  solution  may  be  used  in  full  strength, 
or  diluted  with  equal  parts  of  glycerin  and  water,  or  as  a  lotion  1  part 
in  8.  Sodce  sulphis :  dose,  20  to  60  gr.,  freely  diluted:  as  a  lotion  (anti- 
parasitic),  1  part  in  8:  as  an  injection,  etc.,  2dr.  to  -J  oz.  in  8  oz.  of  fluid. 
Sodcv  hyposulphis  :  dose,  20  to  60  gr.  Calcis  sulphis  :  dose,  10  to  20  gr. 
Magnesias  sulphis:  dose,  10  to  30  gr.  Potasses  sulphis :  dose,  10  to  30  gr. 

[All  the  foregoing,  except  Calcis  sulphis  and  Magnesias  sulphis,  are 
officinal  in  the  U.  8.  Pharmacopoeia.} 


ACIDUM  TARTARICUM-TAKTARIC  ACID,  H8C4H4O.  (or  . 

H,T),=150. 

An  organic  acid  very  widely  diffused:  it  occurs  in  fruits  partly  in  the 
free  state,  and  partly  combined  with  potash  or  lime. 

PREPARATION. — From  "cream  of  tartar" — acid  tartrate  of  potash — 
which  is  derived  from  grape-juice.  The  process  of  preparation  involves 
three  distinct  reactions:  (it  is  a  favorite  test-question  at  examinations). 

1.  The  salt  having  been  boiled  with  sufficient  water,  prepared  chalk 
is  gradually  added,  and  an  insoluble  tartrate  of  lime  is  formed  and  pre- 
cipitates: but  tartaric  acid  is  dibasic,  and  the  other  equivalent  of  basic 
potash  remains  in  the  solution  as  a  neutral  tartrate  (KaT). 

2(KHC4H406)  4-  CaC03  =  Ca04H406 + KSC4H4O,,+ CO,  +  H,O. 

2.  To  precipitate  this  element  of  tartaric  acid  also  as  tartrate  of  lime, 
solution  of  chloride  of  calcium  is  added,  giving  rise  to  formation  of  chlor- 
ide of  potassium,  and  precipitating  the  tartrate  of  lime. 

K,C4H4°.  +  CaCl, = CaC4H406  +  2KC1. 

3.  The  tartrate  of  lime,  having  been  washed,  is  decomposed  by  sul- 


248  MATERIA    MEDICA    AND    THERAPEUTICS. 

phuric  acid,  which  precipitates  an  insoluble  sulphate,  tartaric  acid  being 
left  in  solution. 

CaC4HA+H,S04=H,C4H40.+CaS04. 

CHARACTERS  AND  TESTS. — Tartaric  acid  occurs  in  fine  white  powder, 
of  strongly  acid  taste,  or  in  large  colorless  oblique  rhombic  prisms,  which 
become  luminous  in  the  dark  on  friction.  While  dry,  these  are  perman- 
ent in  air,  but  an  aqueous  solution  becomes  mouldy  on  keeping,  with  for- 
mation of  acetic  acid  (a  change  which  may  be  prevented  by  the  addition 
of  some  rectified  spirit).  A  usual  test  for  tartaric  acid  in  solution  (not 
too  dilute)  is  the  formation  of  a  crystalline  white  precipitate  of  tartrate 
of  potash  on  the  addition  of  acetate  of  potash.  Solutions  neutralized  by 
an  alkali  also  give  with  chloride  of  calcium  a  white  precipitate  of  tartrate 
of  lime  soluble  in  cold  liquor  potassse,  but  falling  again  when  heated. 
Tartaric  acid  may  be  added  to  bicarbonate  of  potash  to  saturation  with- 
out any  precipitate,  but  if  the  bicarbonate  be  added  to  the  acid,  bitartrate 
is  at  once  formed  and  precipitates  (Squire). 

ABSORPTION  AND  ELIMINATION. — Tartaric  acid,  in  moderate  doses,  is 
readily  absorbed,  but  we  do  not  exactly  know  what  changes  it  undergoes 
in  the  system.  That  it  combines  with  earthy  bases  is  probable,  for  Woh- 
ler  found  it  in  the  urine  (by  which  secretion  it  is  eliminated)  in  the  form 
of  tartrate  of  calcium  (Medical  Times,  ii.,  1845).  Dragendorff,  Buchheim, 
and  Pietrowski  found  only  a  small  amount  in  the  urine,  and  conclude 
that  the  greater  part  is  oxidized  in  the  body. 

PHYSIOLOGICAL  ACTION  (EXTERNAL). — On  the  skin,  concentrated  sol- 
utions of  tartaric  acid  produce  temporary  irritation  and  burning. 

PHYSIOLOGICAL  ACTION  (INTERNAL). — Digestive  System. — Small  doses 
have  a  cooling  taste  and  quench  thirst,  but,  if  continued,  may  irritate  the 
stomach,  and  large  doses  cause  purging. 

Very  large  quantities  have  toxic  effects,  though  not  of  so  severe  a 
kind  as  those  of  oxalic,  or  even  of  citric  acid  (Husemann).  A  fatal  re- 
sult is  very  rare,  but  Taylor  records  one  in  which  death  followed  nine 
days  after  taking  1  oz.  of  tartaric  acid  in  solution:  the  symptoms  and  ap- 
pearances were  those  of  gastro-enteritis.  In  other  cases  the  mucous 
membrane  of  the  stomach  and  the  intestines  has  been  found  either  white 
(not  inflamed)  or  ecchymosed,  with  partial  softening. 

Circulatory  System,  etc. — Bobrick  reported  weakening  and  slowing 
of  the  heart-action  in  frogs,  rabbits,  and  men,  after  large  but  non-toxic 
doses;  the  vagus  nerve  was  not  concerned  in  this  effect  (Husemann: 
Arzneimittellehre,  ii.,  894).  According  to  Mitscherlich,  rabbits  die  from 
doses  of  3  to  4  dr.  with  symptoms  of  adynamia,  weakened  heart-action, 
and  difficult  respiration;  the  blood  is  found  fluid,  in  some  cases  light,  in 
others  dark-red. 

Bence  Jones  found  tartaric  acid  increase  acidity  of  urine,  and  lead  to 
excretion  of  uric  acid  in  a  free  state  (Lectures,  1867). 


AMMONIA    GAS.  249 

SYNERGISTS. — Citric  and  other  vegetable  acids. 

INCOMPATIBLES. — Alkalies,  salts  of  mercury  and  lead,  and  vegetable 
astringents  are  incompatible.  Lime  and  magnesia  are  the  best  antidotes. 

THERAPEUTICAL  ACTION  (EXTERNAL). — Fetid  Perspiration. — Schottin 
states  that  tartaric  acid  relieves  this  unpleasant  condition,  and  I  can  cor- 
roborate the  observation.  For  the  feet  it  may  be  used  sprinkled  in  the 
stockings,  or  these  may  be  washed  in  a  strong  solution.  The  powder  may 
also  be  rubbed  into  the  axillae,  with  the  caution  that  if  irritation  be  pro- 
duced it  must  be  replaced  by  some  soothing  powder. 

THERAPEUTICAL  ACTION  (INTERNAL).  —This  acid,  dissolved  and  sweet- 
ened, is  sometimes  used  as  a  refrigerant  drink;  and  it  exerts  a  slightly 
sedative  effect  on  the  circulatory  system.  It  is  sometimes  used  in  place  of 
citric  acid,  but  is  not  so  pleasant  to  the  taste,  nor  so  well  borne  by  the 
stomach.  Of  seidlitz  powders,  the  "  white  paper  "  contains  about  35  to  40 
gr.  of  this  acid,  which,  when  dissolved  and  mixed  with  the  same  quantity 
of  soda  bicarbonate  and  120  gr.  of  tartarated  soda  (the  contents  of  the 
"  blue  paper"),  forms  a  sedative,  refrigerant,  and  slightly  aperient  draught. 
Annesley  considered  tartaric  acid  of  service  in  excessive  secretion  of  mucus 
by  the  stomach  or  intestine.  In  cases  of  ammoniacal  urine  with  cystitis 
from  calculi,  prostatic  disease,  etc.,  I  have  often  found  it  relieve  the  symp- 
toms, and  render  the  secretion  duly  acid  and  clear:  full  doses  of  20  to  40 
gr.  well  diluted  should  be  given  three  or  four  times  daily  for  a  short  time. 

PREPARATION  AND  DOSE. — Acidum  tartaricum:  dose,  10  to  30  gr.  or 
more  dissolved  in  water,  and  sweetened.  For  effervescent  draughts,  20 
gr.  neutralize  26  gr.  of  potash  bicarbonate,  22  gr.  of  the  soda  salt. 

ADULTERATIONS. — Oxalic  acid  and  lime,  sulphuric  acid,  cream  of  tartar, 
and  alum  are  sometimes  found  in  samples  of  tartaric  acid;  also  lead,  which 
may  be  derived  from  the  vessels  in  which  it  is  crystallized. 


AMMOKIUM,  NH4,= 18.— AMMONIA  GAS,  NH,,=1T. 

Ammonia  exists  in  the  air  in  minute  quantity  (probably  as  carbonate), 
in  sea-water  and  many  mineral  waters,  and  rain-water;  in  the  soil  and  in 
animal  excretions,  especially  the  urine.  It  is  a  usual  product  of  decom- 
posing nitrogenous  matter,  and  is  said  to  occur  free  in  certain  plants,  as 
in  the  leaves  of  aconite  and  the  root  of  hellebore.  The  chloride  is  found 
native  near  volcanoes,  and  in  many  coal  mines. 

Its  salts  are  commonly  obtained  from  "  gas-liquor,"  a  product  of  the 
distillation  of  coal  in  gas-manufacture:  when  this  is  neutralized  by  hydro- 
chloric acid,  it  yields  a  chloride,  NH4C1  (sal-ammoniac),  and  from  this  salt, 
when  purified,  are  derived  all  the  other  ammonium  compounds  used  in 
medicine. 


250  MATERIA    MEDICA    AND    THERAPEUTICS. 

CHARACTERS. — Ammonia  itself  is  a  colorless  gas,  which  may  be  lique- 
fied. It  has  a  pungent  odor  and  alkaline  reaction;  it  forms  salts  with 
acids,  and,  as  these  are  very  analogous  in  chemical  relations  to  salts  of 
potash  and  soda,  it  is  believed  that  they  have  a  metallic  base,  which  is 
named  ammonium,  and  is  the  fundamental  radical  of  the  series.  But 
while  potassium  and  sodium  are  simple,  ammonia  is  a  compound  body  or 
radical  (NH4),  acting  like  a  simple  one,  and  until  its  recent  isolation  as  a 
blue  liquid,  its  existence  was  inferred  rather  than  demonstrated  (Smith's 
Commentary). 


LIQUOR  AMMONIA  FORTIOR— LIQUOR  AMMONIA. 

Solutions  of  ammonia  gas  in  water,  the  former  containing  32.5  per 
cent,  and  being  about  one-third  stronger  than  the  simple  liquor;  they  are 
commonly  called  "  spirits  of  hartshorn,"  because  formerly  prepared  by 
heating  scrapings  of  horns  and  hides. 

PREPARATION. — By  heating  sal-ammoniac  with  slaked  lime,  and  dis- 
tilling, the  gas  being  passed  through  wash  bottles  into  a  receiver  con- 
taining water. 

CaH3Oa + 2NH4C1 = CaCls  +  2H,O  +  2NH3 

CHARACTERS  AND  TESTS. — The  stronger  solution  is  colorless,  of  sp. 
gr.  .891  to  .900,  of  characteristic  pungent  odor  and  alkaline  reaction.  A 
piece  of  moist  red  litmus  paper  held  in  the  neck  of  the  bottle  is  at  once 
turned  blue.  The  tests  for  its  purity  are — When  diluted  with  four  times 
its  volume  of  water,  it  gives  no  color  or  precipitate  (a)  with  lime  water, 
showing  the  absence  of  carbonic  acid  ;  or  (b)  with  oxalate  of  ammonia, 
showing  the  absence  of  lime;  or  (c)  with  sulphide  of  ammonium,  proving 
its  freedom  from  lead,  copper,  and  other  metals;  or  (d)  with  ammonio- 
sulphate  of  copper,  showing  its  freedom  from  sulphuretted  hydrogen. 
(e)  When  rendered  acid  by  excess  of  nitric  acid  it  gives  no  precipitate 
with  nitrate  of  silver  or  chloride  of  barium,  showing  its  freedom  from 
chlorides,  bromides,  iodides,  cyanides,  phosphates,  and  sulphates. 

The  properties  of  liquor  ammonise  are  similar,  but  weaker  in  degree. 

COMPOUNDS  OP  AMMONIA. 

AMMONITE  CARBON 'AS-  CARBONATE  OF  AMMONIA, 
N4H18C308=236. 

The  real  constitution  of  this  complex  formula  is  probably, — two  mole- 
cules of  acid  carbonate,  and  one  of  carbonate  of  ammonium. 

PREPARATION. — By  heating  a  mixture  of  chalk  (carbonate  of  lime) 
and  sal-ammoniac  (chloride  ammon.),  when  chloride  of  calcium  and  a 


AMMONIA.  251 

complex  carbonate  of  ammonia  are  formed;  the  latter  distils  over,  and  is 
condensed. 

CHARACTERS. — When  recent  it  is  seen  in  colorless,  translucent,  crys- 
talline masses,  of  strong  characteristic  odor  and  acrid  taste,  markedly 
alkaline  in  reaction,  volatile,  soluble  in  water,  less  so  in  spirit,  and  effer- 
vescent with  acids.  When  exposed  to  the  air  it  gives  off  ammonia  and 
carbonic  acid,  loses  its  odor,  and  crumbles  into  an  opaque  mass  of  bicar- 
bonate of  ammonium.  In  consequence  of  ready  decomposition,  the 
aqueous  solution  of  the  ordinary  salt  will  contain  both  neutral  and  acid 
carbonates.  The  neutral  salt  has  not  been  isolated  in  the  solid  state. 


AMMON1I   CHLORIDUM— CHLORIDE  AMMONIUM— SAL-AMMONIAC, 

NH4C1,=53.5. 

PREPARATION. — Generally  from  gas-liquor,  by  adding  hydrochloric 
acid  to  neutralization,  evaporating  the  liquid,  and  purifying  the  crystals 
by  sublimation. 

CHARACTERS  AND  TESTS. — Occurs  in  pieces  of  the  hemispherical  cakes 
in  which  it  is  sublimed,  of  translucent  fibrous  appearance  and  pungent 
saline  taste — inodorous.  Its  ordinary  form  is  hard  to  powder.  It  is 
soluble  in  one  part  of  boiling  water  and  three  of  cold,  its  solution  being 
attended  by  reduction  of  temperature;  also  soluble  in  rectified  spirit. 
Heated  with  potash,  soda,  or  lime,  it  evolves  ammonia. 

AMMONII  BROMWUM  (y>.  Bromine,  p.  98). 

LIQUOR  AMMONIA  ACETAT1S— SOLUTION  OF  ACETATE  OF  AM- 
MONIA. 

Acetate  of  ammonia,  NH4CaHtO,,=77,  dissolved  in  water,  commonly 
called  spirit  of  Mindererus. 

PREPARATION. — By  gradual  neutralization  of  carbonate  of  ammonia 
with  acetic  acid. 

CHARACTERS  AND  TESTS. — When  pure  and  fresh  this  is  a  limpid,  color- 
less liquid,  without  odor  and  with  strong  saline  taste;  but  unless  carefully 
kept  it  soon  spoils.  With  caustic  alkalies  it  evolves  ammonia,  and  with 
sulphuric  acid,  acetic  vapors. 

AMMONITE    C1TRATIS  LIQUOR— SOLUTION   OF     CITRATE    OF  AM- 
MONIA. 

Citrate  of  ammonia,  3NH4C6H6O,,=243,  dissolved  in  water. 
PREPARATION. — By  neutralizing  a  solution  of  citric  acid  with  strong 
solution  of  ammonia.     It  is  a  colorless  liquid  of  saline  taste. 


252  MATERIA    MEDIOA    AND    THERAPEUTICS. 


AMMONITE  PHOSPHAS— PHOSPHATE  OF  AMMONIA, 
(NH4),HP04,=132. 

PREPARATION. — By  neutralizing  phosphoric  acid  with  ammonia,  the 
latter  being  in  excess. 

CHARACTERS  AND  TESTS. — The  crystals,  which  are  transparent  when 
recent,  become  opaque  on  exposure,  and  part  with  ammonia  and  water. 
Soluble  in  water,  insoluble  in  spirit,  gives  a  characteristic  yellow  precipi- 
tate with  nitrate  of  silver. 

AMMONITE  BENZOA8—BENZOATE  OF  AMMONIA, 
NH4CTH.O, 

PREPARATION,. — By  dissolving  benzoic  acid  in  water,  with  solution  of 
ammonia,  and  crystallizing. 

CHARACTERS  AND  TESTS. — Occurs  in  colorless  laminar  crystals,  which 
are  soluble  in  water  and  alcohol:  they  are  sublimed  by  heat.  Hydro- 
chloric acid  precipitates  benzoic  acid  from  solution,  and  caustic  potash 
heated  with  it  causes  evolution  of  ammonia.  Per-salts  of  iron  give  a 
yellow  precipitate. 

Ammonii  Sulphidum  (Appendix  II.),  (NH4)aS,  =  68. — By  passing 
sulphuretted  hydrogen  into  liq.  ammoniae  to  saturation,  then  adding 
more  liq.  ammoniae. 

NH3  +  H2S=NH4HS  and 
NH4HS+NHs=(NH4)aS 

A  colorless  liquid,  becoming  yellow  when  kept,  of  disagreeable  taste 
and  fetid  odor.  It  is  incompatible  with  almost  all  metallic  and  acid  so- 
lutions. 

Ammonias  JWitras — Nitrate  of  Ammonia,  NH4NO3,=80.  (Placed  in 
the  appendix  only  for  the  preparation  of  nitrous  oxide  gas.) 

ABSORPTION  AND  ELIMINATION. — Ammonia  and  its  carbonate  are  not 
wholly  absorbed  as  such — a  part  becomes  changed  into  chloride  in  the 
stomach  (Rabuteau).  Most  of  the  free  ammonia  combines  with  carbonic 
acid  in  the  organism  (Bellini:  ^British  Medical  Journal,  i.,  1874).  Salts 
of  ammonia  with  organic  acids  (citrate,  etc.)  are  decomposed  in  the  cap- 
illaries, when  the  acids  are  oxidized  and  ammonia  is  set  free.  Compounds 
of  ammonia  with  mineral  acids  form  alkaline  salts  at  the  expense  of  car- 
bonates in  the  blood  (Bellini). 

Though  Lange  did  not  find  ammonia  in  the  air  expired  by  animals 
taking  it  (Archiv  fur  Exper.  Path.,  Bd.  ii.),  other  observers  have  often 
done  so,  and  Bellini  concluded  that  caustic  ammonia  and  the  carbonate, 
when  taken  in  small  doses,  were  entirely  and  very  quickly  eliminated  by 
the  lungs  /  of  large  doses,  some  passed  also  by  other  channels.  Whatever 
salt  was  taken,  carbonate  was  eliminated  by  the  lungs. 


AMMONIA.  253 

There  is  sufficient  evidence  that  the  carbonate,  when  taken  in  moder- 
ate or  even  large  doses,  is  not  excreted,  as  such  by  the  kidneys.  Rabu- 
teau,  took  60  gr.  daily  for  five  days  without  finding  any  in  the  urine, 
which  continued  acid,  whereas  a  mere  trace  of  ammonia  added  directly  to 
the  urine  suffices  to  give  an  alkaline  reaction.  Dr.  Bence  Jones  had  pre- 
viously pointed  out  this  continued  acidity  of  urine  under  ammonia,  and 
suggested  that  the  drug  becomes  so  far  oxidized  in  the  system  as  to  give 
rise  to  nitrous  or  nitric  acid,  which  appears  in  that  secretion  ("  Philosophi- 
cal Transactions,"  1851,  and  Medical  Times,  ii.,  1854).  Only  after  very 
large  doses  (160  gr.  daily)  some  carbonate  of  ammonia  is  eliminated  in 
the  urine,  which  then  becomes  alkaline,  and  deposits  ammonio-magnesian 
phosphate. 

Ammonium  chloride  does  not  readily  decompose  in  the  system;  it  is 
excreted  by  the  urine  and  partly  by  the  saliva  (Rabuteau);  a  small  quan- 
tity passes  out  by  the  skin. 

Frerichs  taught  that  in  uraemia  an  unusual  amount  of  ammonia  car- 
bonate (arising  from  decomposition  of  urea)  circulated  in  the  blood  and 
was  excreted  by  the  lungs,  and,  although  some  doubt  has  been  thrown 
upon  this  by  Dr.  George  Johnson  and  others  (Medical  Times,  i.,  1858),  it 
certainly  occurs  in  some  cases  (cf.  p.  256).  Richardson  has  pointed  out 
that  during  an  actual  attack  of  uraemic  convulsion,  the  amount  of  ammo- 
nia excreted  is  less  than  at  other  times  on  account  of  the  retention  of 
urea  in  the  system  (Lancet,  ii.,  1860).  Gull  found  ammonia,  when  the 
albumen  in  the  urine  was  not  large  in  amount  (Medical  Times,  i.,  1861, 
p.  616).  Unemic  coma  is,  however,  connected  with  the  circulation  of 
urea,  etc.,  rather  than  of  ammonia  (Medical  Times,  i.,  1862). 

PHYSIOLOGICAL  ACTION  (EXTERNAL). — The  vapor  of  carbonate  of  am- 
rnonia  (smelling  salts)  is  stimulant  and  slightly  irritant,  that  of  the  strong 
ammonia  is  intensely  irritant  to  the  whole  of  the  air-passages  and  con- 
junctivse,  and  has  even  caused  fatal  bronchitis.  Liquid  ammonia  is  also 
a  strong  local  irritant;  diluted  with  oil  it  is  " rubefacient,"  but  applied 
in  strength,  and  evaporation  prevented,  it  vesicates,  and  if  injected  under 
the  skin  causes  severe  sloughing.  Oertel  reported  that  the  direct  appli- 
cation of  liquor  ammonise  to  the  air-passages  caused  a  membranous  effu- 
sion similar  to  that  of  croup;  but  very  careful  observations  by  Meyer  on 
the  same  point  verified  only  a  local  catarrhal  inflammation  and  hemor- 
rhage (British  Medical  Journal,  ii.,  1874).  Ammoniacal  urine  commonly 
irritates  the  bladder. 

Ammonia  has  marked  antiseptic  powers:  1  dr.  of  liq.  ammon.  fort,  on 
lint  under  a  bell-jar  preserves  morbid  specimens,  and  the  same  quantity 
with  water  preserves  them  better  than  spirit. 

PHYSIOLOGICAL  ACTION  (INTERNAL). —  Circulatory  System.—  Medici- 
nal doses  of  ammonia  and  its  compounds  quicken  the  heart's  action  and 
capillary  circulation,  but  only  for  a  comparatively  short  time:  such  stimu- 


254  MATERIA   MEDICA   AND    THERAPEUTICS. 

lation  is  not  always  marked  in  healthy  persons — it  is  more  evident  in  the 
weak  and  in  invalids:  there  is  increased  sense  of  warmth,  the  face  be- 
comes flushed,  the  eyes  more  brilliant,  and  the  mental  condition  stimu- 
lated. 

Ten  drops  of  the  liquor,  diluted  with  1  or  2  oz.  of  warm  water  and 
injected  into  a,  vein,  excite  the  heart  so  powerfully  as  to  rouse  a  patient 
from  a  state  of  collapse  (Tibbitts:  Medical  Times,  ii.,  1872).  Larger 
quantities — 30  drops — given  in  the  same  manner,  after  a  momentary 
arrest,  stimulate  intensely,  and  may  induce  convulsion:  still  larger  quan- 
tities cause  momentary  fall  of  arterial  pressure,  then  sudden  and  enor- 
mous rise,  with  corresponding  increase  of  pulse-rate:  this  result  occurs 
equally  after  division  of  the  cord,  hence  it  is  not  due  to  stimulation  of  the 
vaso-motor  centre,  but  of  the  accelerator  nerves  of  the  heart  (Lange). 

On  the  other  hand,  according  to  Rabuteau,  40  grs.  of  carbonate,  dis- 
solved and  injected  into  a  vein,  weaken  the  cardiac  contractions  and  ren- 
der them  irregular,  while  GO  gr.  cause  a  sudden  arrest  of  the  circulation, 
the  heart-muscle  being  paralyzed. 

The  corpuscles  are  altered  by  toxic  doses;  they  cease  to  contain  the 
normal  quantity  of  oxygen,  and  do  not  absorb  it  even  when  shaken  up 
with  the  gas  (Feltz  and  Ritter). 

The  continued  use  of  ammonia  salts  causes  similar  toxic  effects;  the 
pulse  becomes  very  feeble,  and  the  corpuscles  pale  and  wasted,  as  after 
typhoid  fever;  this  is  but  the  recognized  effect  of  all  alkalies.  These 
results  are  reported  by  Cazenave  (Bulletin  de  Therapeutique,  t.  xxxi.), 
yet  Pereira  has  given  15  gr.  thrice  daily  for  two  months  without  apparent 
injury,  and  often  a  scruple  thrice  daily  for  two  or  three  weeks. 

Ammonia  or  its  carbonate  added^  to  blood  outside  the  body  renders  it 
or  keeps  it  fluid,  and,  when  given  internally,  exerts  an  influence  in  the 
same  direction;  Dr.  Richardson  even  thinks  they  have  sometimes  caused 
disintegration  of  clot  already  formed  in  the  vessels  (v.  p.  259).  Coagu- 
lation of  blood  is  not,  however,  due  to  escape  of  ammonia,  as  thought 
probable  at  one  time,  nor  will  ammonia  always  or  wholly  prevent  it.  A 
difference  in  time  of  coagulation  was  the  only  difference  observed  by 
Rabuteau  in  experiments  on  dogs,  for  while  coagulation  of  their  blood 
usually  occurs  in  two  minutes  after  withdrawal,  it  occurred  only  in  ten 
minutes  when  60  gr.  of  ammonia  carbonate  had  been  injected:  the  clot, 
however,  was  firm  and  resistant. 

Chloride  of  ammonium  delays  coagulation  of  blood,  and  when  added 
to  it  with  access  of  air  renders  or  keeps  it  red,  as  do  other  chlorides. 

Nervous  /System. — Ammonia  salts,  in  medicinal  doses,  stimulate  the 
general  nervous  system,  probably  by  quickening  circulation,  but  the  spe- 
cial effect  of  large  doses  is  exerted  on  the  motor  tract  of  the  spinal  cord, 
which  is  stimulated  much  in  the  same  manner  as  by  strychnia.  Convul- 
sions are  produced,  especially  by  strong  intravenous  injection,  and  as 


AMMONIA.  255 

these  occur  equally  when  communication  with  the  brain  is  severed,  they 
are  not  cerebral  in  origin  (Lange):  neither  do  they  start  in  the  periphe- 
ral nerves,  for  they  take  place  if  the  blood  be  cut  off  from  these  nerves 
by  ligature  (Funke) :  we  conclude  them,  therefore,  to  be  of  spinal  origin 
(Pfiilger'sArchiv.,  Bd.  ix.),  and  section  of  the  nerve-trunk  of  a  limb  stops 
their  occurrence.  Prostration  follows  the  convulsive  seizure,  and  a  par- 
tial paralysis  of  the  hinder  limbs  of  animals  (Rabuteau  and  Behier: 
Comptes  Jtendus,  Soc.  Biol.,  1873).  Spiegelberg  made  "certain  experi- 
ments in  order  to  test  the  opinion  of  Frerichs  that  the  convulsions  of 
albuminuria  were  due  to  the  circulation  of  ammonia  carbonate,  and  when 
he  had  injected  as  much  as  6  gr.  of  that  salt  into  the  veins  of  a  dog,  gen- 
eral convulsions  occurred  with  clonic  spasm  and  trismus,  the  pupil  was 
dilated,  general  sensibility  was  reduced,  and  coma  set  in;  after  an  hour 
and  a  half,  free  salivation  and  urination  took  place,  and  the  animal  recov- 
ered, remaining  stupid  for  some  time:  larger  doses  caused  vomiting, 
afterward,  tetanus  and  coma;  the  vessels  were  found  full  of  dark  fluid 
blood  (Lancet,  ii.,  1870).  It  is  probable  that  ammonia  is  a  direct  and  in- 
tense stimulant  of  respiratory  centres  in  the  medulla. 

The  full  effects  of  chloride  of  ammonium  are  not  often  exemplified, 
but  in  the  case  of  a  lunatic  who  swallowed  a  large  (unknown)  quantity, 
there  were  vomiting,  giddiness,  shivering,  depression,  delirium,  convul- 
sion, and,  later,  collapse  so  complete  as  to  simulate  death:  recovery  was 
effected  with  galvanic  and  other  powerful  stimuli,  and  then  tetanic 
spasms  came  on  (C.  Browne:  Lancet,  i.,  1S68).  Temperature  is  raised 
under  the  physiological  action  of  the  chloride;  lowered  under  the  other 
salts. 

Digestive  System. — Ammonia  and  its  carbonate  have  a  direct  antacid 
effect  on  the  gastric  secretions,  and  moderate  doses  induce  a  sense  of 
warmth  and  stimulation  at  the  epigastrium.  More  than  5  gr.  is  likely  to 
irritate;  10  gr.  will  commonly  nauseate,  and  20  gr.  will  produce  vomit- 
ing. Diarrhoea  is  sometimes  observed  from  continued  medicinal  doses 
(Cazenave).  Liquid  ammonia,  when  swallowed,  acts  as  an  irritant  poi- 
son, and  in  fatal  cases  has  caused  inflammation  and  erosion  of  the  upper 
part  of  the  alimentary  tract:  occasionally  it  has  acted  upon  the  larynx, 
and  induced  rapidly  fatal  oadema  glottidis.  Death  has  been  caused  by 
2  dr.  of  the  strong  solution;  in  other  cases  by  1  oz.  (British  MedicalJour- 
nal,  i.,  1878),  and  %  pint  (British  Medical  Journal,  ii.,  1878). 

/Secretion  and  Excretion. — Medicinal  doses  of  ammonia,  under  favor- 
able conditions  of  warmth,  etc.,  increase  most  of  the  secretions,  such  as 
those  of  the  skin,  the  kidneys,  and  the  bronchial  mucous  membranes. 
The  liq.  ammoniae  acetatis  has  a  special  action  on  the  skin  and  kidneys, 
the  carbonate  on  the  lungs,  the  chloride  on  the  liver  and  kidneys  (Stew- 
art, Rutherford).  The  pulmonary  secretions  and  the  bile  are  also  ren- 
dered more  fluid — ammonium  chloride  especially  stimulates  the  latter  se- 


256  MATERIA    MEDICA    AND    THERAPEUTICS. 

cretions.     The  alkaline  salts  of  ammonia  are  not  "  remote  antacids,"  i.e., 
they  do  not  render  the  urine  alkaline. 

Influence  on  Nutrition —  Urea. — Although  ammonia  is  seldom  taken 
long1  enough  in  medical  practice  to  directly  affect  nutrition,  there  is  evi- 
dence that  its  continued  use  will  produce  debilitating  effects  like  other 
alkalies — as  indeed  might  be  expected  from  its  influence  on  the  blood. 
Cazenave  has  reported  pallor,  anorexia,  debility,  and  emaciation;  and 
Huxham,  a  case  in  which  hectic,  hemorrhage^  and  general  marasmus  fol- 
lowed upon  the  habitual  eating  of  ammonia  carbonate  (Essay  on  Fe- 
vers). Prout  noted  a  great  increase  in  the  amount  of  urea  excreted 
under  citrate  of  ammonia,  taken  for  dyspepsia,  and  the  same  thing  has 
been  recorded  in  cases  of  debility  with  irritable  bladder,  and  pale  urine 
of  low  sp.  gr.  (Medical  Times,  ii.,  1863).  Rabuteau,  however,  as  the  re- 
sult of  experiments  on  himself  in  health  with  75  gr.  of  citrate  daily,  found 
that  urea  was  slightly  diminished,  and  also  sulphates,  but  that  phosphates 
were  much  increased  in  amount.  Richardson  maintains  that  ammonia 
suspends  oxidation,  and  checks  formation  of  all  downward  products  of 
albumen,  and  retards  nutrition  (Medical  Times,  i.,  1862,  ii.,  1866). 
There  are  not  many  observations  on  this  point,  but  according  to  Lange, 
ammonia  carbonate  may  itself  furnish,  by  decomposition,  an  additional 
quantity  of  urea. 

Under  the  chloride,  however,  urea  is  distinctly  increased,  and  oxida- 
tion of  tissue  rendered  more  active. 

The  iodide  and  bromide  of  ammonium  exert  the  absorbent  and  seda- 
tive effects  of  alkaline  bromides  generally;  if  anything,  they  are  more 
active  and  less  depressing  than  the  corresponding  salts  of  soda  and  pot- 
ash. 

SYNERGISTS. — Diffusible  stimulants,  heat,  and,  according  to  Gubler, 
opium  and  iodine.  Both  Gull  and  Paget  have  pointed  out  that  ammo- 
nia aids  the  action  of  iodide  of  potassium,  and  it  has  been  asserted  that 
5  gr.  of  the  latter,  with  3  gr.  of  ammon.  carb.,  is  equivalent  to  8  gr.  of 
the  iodide  alone  (British  Medical  Journal,  i.,  1874).  Volatile  ammonia 
assists  also  the  action  of  anti-spasmodics,  such  as  valerian,  castor,  etc. 
Other  alkalies  and  bases  assist  its  antacid  power. 

ANTAGONISTS — IXCOMPATIBLES. — Cold,  emollient  drinks,  quinine,  tan- 
nin, interfere  with  the  action  of  ammonia,  and  are  "  dynamic  antidotes  " 
(Gubler). 

Incompatibles  are  acids  and  fixed  alkalies,  salts  of  iron  (except  the 
tartarated  iron),  calomel,  lead  salts,  etc.  Freely  diluted,  ammonia  and 
its  carbonate  may  be  used  as  antidotes  to  mineral  acids.  Christison, 
Pereira,  and  others,  consider  them  also  antidotal  to  prussic  acid:  they 
certainly  have  dynamic  effects,  opposite  in  character  to  those  of  the  acid, 
though  they  do  not  chemically  neutralize  it:  they  antagonize  also  the 
toxic  effects  of  alcohol,  and  in  some  degree  those  of  animal  poisons. 


AMMONIA.  257 

THERAPEUTICAL  ACTION  (EXTERNAL). — Neuralgia — Rheumatism,  etc. 
— The  strong  liquor  ammonias  has  been  used  as  a  counter-irritant,  or  a 
rapid  vesicant,  in  cases  of  muscular,  neuralgic,  and  rheumatic  pain,  and 
to  relieve  deeper-seated  inflammation,  for  instance,  of  the  tonsil  and  fau- 
ces, by  derivation  to  the  skin.  For  such  purposes  the  ammonia  liniment 
may  be  rubbed  in,  or,  if  vesication  be  necessary,  it  may  be  secured  in  the 
course  of  five  minutes  by  the  strong  liquor  applied  on  lint.  Dr.  Waring 
recommends,  as  a  simple  method,  to  fill  the  lid  of  a  wooden  pill-box  with 
circular  pieces  of  lint  to  above  the  rim,  saturate  with  the  liquid,  and  in- 
vert over  the  part.  M.  Gondret  introduced  a  vesicating  ointment  made 
with  ammonia  and  one-fourth  part  lard  and  olive  oil,  and  it  is  commonly 
used  in  France.  M.  Ducros  advised  painting  the  liquor  over  the  palate 
and  gums  for  relief  of  tic. 

Falling  off  of  the  Hair. — The  stimulating  properties  of  ammonia  are 
highly  useful  in  promoting  growth  of  hair  when  it  has  been  thinned  by 
debility  or  illness.  Half  an  ounce  of  the  strong  liquor,  with  almond  oil, 
rosemary  spirit,  and  honey-water  to  about  6  oz.  is  a  good  proportion  (E. 
Wilson). 

Amenorrhoea — Pruritus. — In  cases  of  chlorotic  amenorrhcea,  a  stimu- 
lating vaginal  injection  of  about  1  dr.  of  liq.  ammoniae  to  a  pint  of 
warm  milk  has  been  found  useful  by  Dr.  Ashwell,  and  I  have  fre- 
quently ordered  it  with  advantage,  the  breasts  being  stimulated  at  the 
same  time  by  friction  with  weak  ammonia  liniment.  Dr.  Dewees  has 
recorded  the  cure  of  an  obstinate  case  of  pruritus  pudendi  by  a  similar 
injection. 

Local  Inflammations. — Lotions  containing  ammonium  chloride  are 
very  useful  in  inflammatory  swellings  of  muscles,  joints,  lymphatic  and 
other  glands,  and  sometimes  in  the  hydroceles  of  children — 2  dr.  may  be 
used  to  4  or  6  oz.  of  spirit  and  water. 

In  orchids  and  in  milk  engorgements  with  heat  and  tension  of  the 
breasts,  the  same  application  is  cooling  and  absorbent.  Gueneau  de 
Mussy  recommends  for  the  latter  cases  an  ointment  containing  5  parts  of 
the  chloride  mixed  with  1  of  camphor  and  30  of  lard,  to  be  used  fre- 
quently. It  is  said  that  threatening  abscess  may  be  aborted  by  the  con- 
tinued application  of  compresses  wet  with  spirit  of  rosemary  containing 
about  1  dr.  of  the  salt  to  the  pint,  and  if  an  abscess  has  formed  of  indo- 
lent character,  such  as  bubo  often  is,  it  may  be  stimulated  to  heal  by  the 
injection  of  sal-ammoniac  solution  after  withdrawal  of  some  pus  (Rank- 
ing, i.,  1871). 

Acne. — In  chronic  cases  of  acne  simplex  with  comedones,  a  lotion 
containing  the  chloride  with  alum  and  sulphuret  of  potash  is  sometimes 
an  effective  resource. 

Stings — Snake-Site. — Dilute  liquor  ammonias  relieves  the  pain  that 
follows  the  stings  of  venomous  insects,  wasps,  etc. ;  it  should  be  freely 
VOL.  I.— 17 


258  MATEBIA    MEDICA   AND    THERAPEUTICS. 

rubbed  into  the  part,  and  given  internally  if  there  be  tendency  to  col- 
lapse. 

Professor  Halford  (Melbourne)  has  strongly  advocated  intravenous 
injection  of  ammonia  in  snake-bite,  using  15  to  30  min.  of  the  liquor,  dilu- 
ted with  3  or  4  parts  of  water,  both  as  antidotal  to  the  poison,  and  as  a 
general  stimulant.  Many  cases  have  recovered  under  this  treatment,  but 
there  is  yet  much  doubt  as  to  how  far  it  may  be  depended  upon:  in  some 
of  them  it  is  probable  that  the  bites  were  not  of  fatal  character,  and,  when 
experiments  were  repeated  with  more  accuracy,  ammonia,  even  injected 
by  Professor  Halford,  did  not  avert  a  fatal  result  (Medical  Times,  ii., 
1876).  It  has  also  been  found  powerless  against  the  bite  of  Indian  snakes, 
which  are  more  poisonous  than  those  of  Australia  (Fayrer,  Short,  Brun- 
ton,  Ewart):  in  some  cases  death  followed  even  more  quickly  than  usual 
after  the  injection  (Report  of  Commission). 

The  intravenous  injection  of  liq.  ammonise  is  a  subject  of  much  import- 
ance, and  one  that  deserves  more  general  attention  than  has  yet  been 
given  to  it:  it  is  not  free  from  risk  and  danger,  especially  if  the  large 
dose  of  30  min.  be  used,  but  in  suitable  quantity  it  has  powerfully  stimu- 
lated the  heart,  and  revived  cases  apparently  in  articulo  mortis. 

Shock  and  Collapse  from  Injury,  etc. — Cases  of  fracture  and  lacera- 
tion accompanied  with  collapse  and  treated  by  ammonia-injections  have 
been  recorded  by  Mr.  Tibbitts.  In  one  man,  40  drSps  with  2  oz.  of  %varm 
water  were  passed  into  one  of  the  veins  of  the  arm,  and,  after  temporary 
arrest  of  breathing,  a  violent  convulsion  occurred;  but,  on  subsidence  of 
this,  general  stimulation  was  evident,  and  he  rallied  for  several  hours.  In 
a  second  case,  30  drops  were  injected,  with  a  somewhat  similar  result;  in 
the  third  patient,  when  only  10  drops  were  given,  pulse  and  respiration 
were  at  once  restored,  vomiting  occurred,  and  recovery  followed  (Medi- 
cal Times,  ii.,  1872). 

Recovery,  though  only  temporary  in  character,  followed  a  similar  in- 
jection given  during  collapse  in  severe  scarlet  fever  (British  Medical 
Journal,  i.,  1877),  and  in  the  same  condition,  occurring  during  puerperal 
fever,  Tyler  Smith  injected  30  min.  with  3  parts  of  water,  and  ultimate 
recovery  followed;  but  two  cases  thus  treated  by  Mr.  Spencer  Wells 
proved  unsuccessful  (British  Medical  Journal,  ii.,  1869). 

JVarcosis. — Neild  injected  30  drops  of  ammonia  on  four  separate  occa- 
sions in  a  patient  fatally  narcotized  by  chloroform  ;  temporary  recovery 
occurred  each  time  (Medical  Times,  i.,  1871).  In  a  case  of  opium-poison- 
ing, when  40  gr.  had  been  taken,  and  death  was  imminent,  revival,  though 
only  for  a  time,  also  followed  directly  on  ammonia-injection  (British 
Medical  Journal,  ii.,  1872).  Mr.  Richards  has  specially  drawn  attention 
to  the  value  of  ammonia-injections  in  alcoholic  coma,  and  has  shown  that 
some  of  Dr.  Halford's  patients  who  had  much  brandy  (one  got  a  bottle 
and  a  half  in  three  hours)  were  really  more  comatose  from  the  alcohol 


AMMONIA.  259 

than  from  the  bite,  and  hence  their  recovery.  He  remarks  on  the  im- 
portance of  a  slow  injection,  and  recommends  10-min.  doses  (Lancet,  i., 
1880,  p.  115). 

Exhaustion. — In  a  case  where  extreme  exhaustion  was  consequent  on 
prolonged  suppuration,  15  min.  were  injected  into  a  vein,  and  again  eight 
hours  afterward  with  permanent  good  result  (British  Medical  Journal, 
i.,  1877);  some  of  the  caustic  entered  the  cellular  tissue,  and  caused  local 
sloughing,  and  in  other  cases,  where  injection  has  been  made  purposely 
into  this  tissue,  serious  ulceration  and  abscess  have  followed  (Medical 
Times  and  Lancet,  i.,  1870). 

THERAPEUTICAL  ACTION  (INTERNAL). — Exhaustion — Alcoholism,  etc. 
— One  of  the  most  frequent  uses  of  ammonia,  and  one  which  it  commonly 
serves  very  well  given  by  the  mouth  in  the  ordinary  manner,  is  to  quicken 
the  general  circulation  and  to  revive  failing  heart-action  in  cases  of  ex- 
haustion and  threatened  syncope  from  almost  any  cause:  being  volatile, 
it  diffuses  and  acts  rapidly.  The  vapor  of  the  carbonate,  as  disengaged 
from  "smelling  salts,"  is  sometimes  usefully  given  by  inhalation  in  the 
same  class  of  cases,  and  the  vapor  of  liquor  ammonias  has  been  utilized 
in  partial  asphyxia,  and  in  the  semi-coma  of  drunkenness.  In  several 
extreme  cases  of  alcoholism,  wherein  relapses  were  frequent,  I  have  known 
the  aromatic  spirit  of  ammonia  in  drachm-doses  every  hour  or  two  "steady  " 
the  patient  very  markedly;  it  has  acted  better  than,  e.g. ,  vinegar,  which 
seemed  to  increase  liver  congestion  and  give  only  temporary  relief  to 
symptoms.  The  depression  and  dyspepsia  which  commonly  follow  exces- 
sive use  of  alcohol  are  also  well  treated  by  ammonia  compounds,  especially 
if  combined  with  valerian:  in  the  prostration  of  delirium  tremens,  the 
same  remedies  are  very  useful. 

Tlwombosis — Embolism. — Rapid  separation  of  fibrine  in  the  heart- 
cavities  seems  to  occur  previous  to  death  in  many  acute  exhausting  dis- 
eases, such  as  pneumonia,  croup,  peritonitis,  etc.,  and  after  prolonged  or 
difficult  parturition.  Dr.  B.  W.  Richardson  states  that  advantage  may 
be  derived  in  such  apparently  hopeless  condition  from  the  use  of  liquor 
ammonise  TTlx.  every  hour,  alternately  with  iodide  of  potassium  (Ranking, 
ii.,  1872).  Dr.  Shepherd  Fletcher  (Manchester)  has  reported  a  well- 
marked  case  of  embolism  occurring  in  a  puerperal  woman  and  recovering 
under  5-gr.  doses  of  ammonia  carbonate  given  every  hour  (British  Medi- 
cal Journal,  i.,  1864),  and  Dr.  Philipson  has  recorded  another  illustration 
of  the  same  character  (British  Medical  Journal,  1865).  More  recently, 
Dr.  Richardson  has  written  to  point  out  distinctive  signs  of  the  separation 
of  fibrinous  coagula  in  the  large  thoracic  vessels— e.g.,  dyspnoea  with 
open  air-passages,  fulness  of  the  neck-veins,  feeble  pulse  with  tumultuous 
heart-action,  and  weakened  first  sound:  for  such  conditions  he  strongly 
advises  the  persistent  administration  of  ammonia,  not  so  much  as  a  stimu- 
lant, but  as  a  solvent  of  blood-clot,  and  preventive  of  putrefaction  (Lancet, 


260  MATERIA    MEDICA    AND    THERAPEUTICS. 

i.,  1875).  I  cannot,  however,  yet  adopt  so  sanguine  a  view  of  this  medi- 
cation (v.  p.  254). 

Pyrexia. — In  acute  pyrexial  and  inflammatory  conditions,  solutions  of 
acetate  and  citrate  of  ammonia  relieve  many  of  the  symptoms  by  promo- 
ting secretion  from  the  skin  and  kidneys. 

Typhus  and  Typhoid  Fever. — In  adynamic  stages  of  these  fevers, 
ammonia  has  often  been  used  but  not  always  with  advantage;  thus  Stille 
reports  its  failure,  though  largely  given  during  an  epidemic  of  typhus  at 
Philadelphia.  There  is  reason  to  believe  that  the  amount  of  ammonia 
circulating  in  the  blood  is  unduly  increased  in  these  maladies,  and  this 
would  be  a  reason  against  using  it:  certainly  its  administration  is  very 
distasteful  to  the  patients. 

Scarlatina. — On  the  other  hand,  there  is  much  clinical  evidence  of  the 
value  of  ammonia  in  this  fever.  De  Witt,  Peart  (1802),  Wilkinson,  and 
Strahl  have  written  specially  in  its  praise,  and  many  illustrations  of  its 
value  have  been  given  by  Hillier,  Camden,  Graham,  Sisson,  Langdon 
Down,  and  others  (Lancet,  1860,  1864,  1870;  Medical  Times,  1858,  1862, 
1873,  and  "London  Hospital  Reports/'  vol.  i.).  From  3  to  6  gr.  of  .car- 
bonate, freely  diluted,  are  to  be  given  every  one  or  two  hours,  until  im- 
provement occurs:  it  determines  to  the  skin,  and  perhaps  thus  hastens 
elimination  of  the  poison.  I  have  found  it  especially  useful  in  cases  ac- 
companied by  malignant  sore  throat.  Dr.  Down  refers  to  192  cases  oc- 
curring in  one  epidemic  at  Earlswood  Asylum;  78  had  severe  angina,  and 
49  were  malignant  cases:  all  received  5  gr.  of  the  carbonate  every  four 
hours,  and  were  otherwise  treated  alike:  alcoholic  stimulants  were  used 
in  moderation.  Ten  only  died,  and  of  these  seven  were  tuberculous,  and 
considering  the  low  resisting  power  of  imbeciles  this  result  is  good.  He 
considered  the  remedy  diminished  febrile  excitement  and  calmed  the  ner- 
vous system:  it  was  taken  readily  without  pain  to  the  throat. 

Chest  Diseases. — In  acute  stages  of  pneumonia,  bronchitis,  or  pleurisy, 
the  acetate  or  citrate  of  .ammonia  is  often  serviceable.  In  asthenia  cases, 
the  later  chronic  conditions  of  bronchitis,  and  in  senile  catarrh,  the  car- 
bonate and  liquor  are  good  stimulant  expectorants,  being  eliminated  in 
part  by  the  pulmonary  membrane,  they  modify  its  condition  and  thin  the 
secretion.  Ammonium  chloride  is  also  valuable  in  such  conditions,  and  in 
asthenic  lung-congestions:  it  may  at  first  increase  pyrexia,  but  generally 
facilitates  the  expectoration,  "  softens  the  cough,"  and  improves  appetite. 
Dr.  Patton  has  written  to  commend  the  carbonate  in  acute  pneumonia, 
and  the  chloride  in  later  stages  (Practitioner,  vol.  vi.). 

In  the  bronchitis  of  measles,  and  of  rachitis,  ammonia  is  commonly  and 
advantageously  used, — Sir  W.  Jenner,  indeed,  speaks  of  it  as  the  remedy 
in  the  lung-affections  of  the  latter  malady,  which  are  generally  asthenic 
and  tend  to  collapse  (Medical  Times,  i.,  1860).  On  the  other  hand, 
Dr.  Eustace  Smith  maintains  that  if  too  early  given  to  children  with 


AMMONIA.  261 

bronchitis   it   may   determine   even   a  fatal   issue   (Medical   Times    i 
1873). 

Group.— In  the  later  stages,  when  the  membrane  is  more  or  less 
loosened,  and  perhaps  capillary  bronchitis  is  present,  carbonate  of  am- 
monia may  prove  a  useful  stimulant  expectorant  or  emetic. 

Pertussis.— I  have  seen  relief  given  to  the  cough  in  later  stages  by 
inhalation  of  ammonia  vapor,  and  Mr.  Grantham  has  devised  a  simple 
method  of  effecting  this  by  adding  1  oz.  of  the  liquor  to  1  gallon  of  boil- 
ing water  in  a  bucket  or  bath,  and  then  putting  in  a  red-hot  brick  (Brit- 
ish Medical  Journal,  ii.,  1871).  The  atmosphere  of  gas-works  has  often 
relieved  chronic  cases,  a  good  effect  which  has  been  traced  to  the  volatile 
sulphide  of  ammonium. 

Bronchial  Catarrh — Hoarseness. — The  chloride  of  ammonium  in  va- 
por deserves  trial  in  obstinate  cases  of  this  kind,  and  Dr.  H.  Beimel  in- 

3  O 

troduced  an  arrangement  of  three  bottles,  one  containing  liquor  ammo- 
nia, another  hydrochloric  acid,  and  a  third  "  wash-bottle  "  with  water, 
through  which  air  impregnated  with  the  vapor  was  drawn  for  inhalation 
(Lancet,  ii.,  1867):  it  has  not  come  into  general  use.  Liebermann  has 
suggested  another  form  of  apparatus  for  inhaling  it  (Bulletin  de  Thera- 
peutique,  1873). 

The  bromide  is  of  service  in  capillary  bronchitis  (Bartholow),  in  per- 
tussis, and  other  spasmodic  coughs. 

The  chloride  in  lozenge  and  vapor  has  also  been  advised  for  hoarse- 
ness and  granular  sore  throat,  but  the  stimulus  at  first  sometimes  aggra- 
vates the  symptoms. 

Nerve  Diseases — Migraine. — The  acetate  of  ammonia  in  1  to  2 -dr. 
doses  will  often  relieve  sick-headache.  The  chloride,  in  10  to  20-gr.  doses, 
is  indicated  in  bilious  and  nervous  forms  occurring  in  the  young,  and  in 
delicate  over-worked  women, — "  it  stimulates  the  sensory  nerves,  and 
regulates  the  vaso-rnotors  "  (Anstie:  Practitioner,  vol.  i.). 

In  headache  connected  with  menorrhagia  it  is  said  to  be  more  useful 
than  in  that  connected  with  irregular  or  suppressed  menstruation  (Baral- 
lier  :  Bulletin  de  Therapeutique,  1859). 

Neuralgia. — In  true  neuralgia,  the  chloride  is  often  of  great  value,  as 
Dr.  Clifford  Allbutt  states  after  observation  of  fifty  cases  (Medico-  Chi- 
rurgical  Review,  January,  1872):  it  is,  however,  very  nauseous  to  some 
patients. 

In  tic-douloureux,  or  facial  neuralgia,  especially  if  there  be  a  marked 
rheumatic  element  and  the  lower  jaw  be  affected,  £-dr.  doses  of  chloride 
should  be  given  at  short  intervals,  for  four  doses:  relief  will  probably 
have  then  set  in  if  this  remedy  is  going  to  benefit  (Watson  :  "  Lectures," 
vol.  i.).  In  cases  accompanied  with  heat  and  swelling,  Brenchley  recorded 
marked  relief  to  pain  and  lowering  of  temperature  under  this  treatment 
(Ranking,  ii.,  1858). 


262  MATERIA    MEDICA    AND   THERAPEUTICS. 

In  hemicrania  from  nerve-prostration  it  is  often  curative  (Medical 
Times,  i.,  1875),  and  in  sciatica  I  have  found  either  carbonate  or  chloride 
valuable,  more  or  less  permanently  when  the  pain  is  worst  when  the  pa- 
tient is  in  the  standing  or  sitting  posture.  In  intercostal  neuralgia,  in 
anaemic  or  suckling  women,  in  hepatalgia,  and  in  ovarian  neuralgia,  Dr. 
Anstie  also  reported  much  benefit  from  the  chloride;  and  of  the  latter  mal- 
ady Dr.  W.  Curran  has  reported  six  severe  cases  marked  by  acute  pain,  py- 
rexia,  vomiting,  etc.,  occurring  mostly  at  a  period,  and  accompanied  with 
fulness  over  the  region  of  the  ovary,  all  much  relieved  by  the  chloride  in 
15-gr.  doses,  which  were  given,  however,  with  5  min.  of  aconite  (Ranking, 
ii.,  1868). 

Dysmenorrhcea. — The  acetate  of  ammonia  will  often  relieve  the  pain 
of  congestive  dysmenorrhcea.  I  have  frequently  prescribed  it  with  suc- 
cess, especially  if  there  be  a  sub-inflammatory  or  turgescent  state  of  mu- 
cous membrane,  or  when  suppression  has  occurred  from  cold,  shock,  or 
fatigue  (British  Medical  Journal,  i.,  1878,  etc.). 

Uterine  Disorder,  etc. — The  chloride  has  often  produced  good  results 
in  amenorrhoea  (Cholmeley  :  Practitioner,  vol.  ii.),  and  Dr.  Anstie  ad- 
vised it  in  cases  marked  by  general  feebleness  rather  than  by  anaemia. 
Dr.  Atlee  states  that  the  salt  has  in  his  practice  caused  the  diminution  of 
fibroid  tumors  (British  Medical  Journal,  i.,  1868).  This  observation  may 
be  compared  with  that  of  Dr.  Rae,  who  asserts  that  the  same  salt  is  val- 
uable in  goitre  and  glandular  enlargements  (Ranking,  ii.,  1858),  but  there 
is  not  much  evidence  on  these  points. 

Myalgia. — For  this  variety  of  pain,  Dr.  Anstie  affirms  "  nothing  in 
the  whole  list  of  remedies  comes  near  the  chloride  in  efficiency,"  and  H. 
Jones  speaks  of  its  power  in  muscular  rheumatism  "  as  remarkable  and 
positive  "  (Lancet,  ii.,  1859). 

Hysteria. — Ammonia  relieves  several  of  the  symptoms  of  this  disorder, 
such  as  the  lassitude  and  tendency  to  fainting,  and  the  flatulent  disten- 
sion of  the  stomach.  The  aromatic  spirit  is  a  good  preparation  in  com- 
mon use.  The  liquor  with  asafoatida  or  valerian  is  still  more  effective, 
t)ut  nauseous;  it  has  some  power  in  staying  convulsive  attacks  of  hyster- 
ical character. 

Dyspepsia — Acidity,  etc. — In  cases  where  flatulence  with  acidity  are 
marked  symptoms,  ammonia  will  relieve  by  its  alkalinity  and  by  stimulat- 
ing the  stomach  to  contract  and  expel  flatus;  it  is  usefully  combined  with 
other  remedies — the  carbonate  or  aromatic  spirit  with  soda  or  bitters. 
The  chloride  with  hydrochloric  acid  relieves  in  some  cases  when  the  tongue 
is  furred  and  the  biliary  secretion  deficient  (British  Medical  Journal, 
i.,  1875).  For  gastric  and  intestinal  catarrh  also,  it  is  commonly  given 
in  Germany — not  so  in  England. 

Hepatic  Disorders. — In  various  forms  of  hepatic  disorder  accompanied 
with  congestion,  ammonium  chloride  is  a  valuable  remedy,  perhaps  not 


AMMONIA.  263 

yet  sufficiently  known  in  this  country.  Dr.  Murchison  recommended  it 
in  "functional  liver-disorder"  accompanied  with  lithaemia,  and  Dr.  Anstie 
in  suppression  of  biliary  secretion  consequent  on  nerve-shock.  It  is  much 
used  abroad  in  catarrh  of  the  bile-ducts,  and  in  the  jaundice  dependent  on 
this  condition;  also  in  hepatic  dropsy;  but  perhaps  its  best  effects  are 
seen  in  passive  hepatic  congestion  when  there  is  deficient  intestinal 
secretion  with  loaded  urine,  constipation,  coated  tongue,  and  general 
"bilious"  condition.  As  already  stated,  the  chloride  stimulates  a  due 
secretion  of  bile  and  increases  the  excretion  of  urea.  Dr.  Stewart,  of  the 
Indian  service,  has  especially  drawn  attention  to  the  value  of  this  remedy 
in  hepatitis,  and  even  hepatic  abscess,  and  has  found  it  act  better  in  acute 
than  in  chronic  stages  of  these  maladies.  If  the  skin  be  dry,  he  orders 
first  the  acetate  of  ammonia  and  afterward  20  gr.  of  chloride  every  four 
or  six  hours:  a  feeling  of  warmth  and  exhilaration  is  produced,  hepatic 
pain  is  quickly  and  markedly  relieved,  perspiration  and  urine  are  freely 
secreted,  and  sleep  commonly  follows  (Lancet,  1870;  British  Medical 
Journal,  ii.,  1878). 

Hemorrhage. — In  hemorrhage  of  different  kinds,  usually  passive  in 
character,  the  chloride  is  praised  by  Copland,  who  gave  it  with  hydro- 
chloric acid.  It  is  not  much  used,  but  Warburton  Begbie  has  seen  good 
results  from  doses  of  20  gr.  in  hsematuria:  in  the  illustrative  case  recorded 
by  him,  there  was  no  definite  cause  for  the  malady  (Lancet,  ii.,  1875). 

Urinary  Disorder. — In  acute  albuminuria,  the  liquor  ammoniseacetatis 
is  often  useful,  as  first  noticed  by  Addison  (Lancet,  ii.,  1855),  and  in 
diabetes,  Barlow,  Golding-Bird,  and  Bouchardat  specially  valued  the  car- 
bonate as  being  a  stimulant  and  a  nitrogenous  substance  ( Guy's  Reports, 
vol.  v.,  etc.).  Basham  recommended  the  phosphate  to  be  given  with  the 
carbonate  and  lemon-juice  (British  Medical  Journal,  i.,  1869).  Prout 
also  thought  the  citrate  serviceable,  but  rather  as  a  diaphoretic  than  as 
possessing  specific  powers.  The  sulphide  has  been  recommended  to  les- 
sen morbid  appetite  in  diabetes,  but  it  does  not  diminish  the  excretion  of 
sugar  (Garrod),  and  ammoniacal  salts  have  not  retained  their  reputation 
in  this  serious  malady. 

In  Vesical  Catarrh  and  Prostatitis,  the  chloride  has  proved  useful, 
and  in  a  case  of  irritable  bladder,  with  pale  urine  of  low  sp.  gr.,  and 
deficient  in  urea,  much  relief  was  apparently  given  by  the  citrate;  the 
excretion  of  urea  was  at  once  increased  under  its  use  (Medical  Times,  ii., 
1863).  The  benzoate  of  ammonia  is  valuable  in  chronic  catarrhal  cystitis, 
with  phosphatic  deposit;  also  in  scarlatinal  dropsy  (Lancet,  ii.,  1861, 
Garrod:  Medical  Times,  1864). 

PREPARATIONS  AND  DOSE. — Liquor  ammonia?  fortior:  dose,  3  to  10 
min.  well  diluted,  but  seldom  used  internally.  Liquor  ammonite:  dose, 
10  to  30  min.  well  diluted.  Spiritus  ammonias  futidus  (with  asafoatida): 
dose,  30  to  60  min.  Ammonias  carbonas:  dose,  3  to  10  gr.  or  more  as  a 


264  MATERIA    MEDICA   AND    THERAPEUTICS. 

stimulant;  30  gr.  as  an  emetic.  Spiritus  ammonias  aromaticus  (sal- 
volatile);  dose,  15  to  60  min.  Ammonii  chloridum  (sal-ammoniac): 
dose,  5  to  20  gr.  or  more.  Ammonii  bromidum  :  dose,  2  to  20  gr.  Am- 
monii iodidum  (riot  officinal):  dose,  1  gr.  and  upwards.  Liquor  ammonioB 
acetatis  (spirit  of  Mindererus):  dose,  2  to  6  dr.  diluted  freely.  Liquor 
ammonias  citratis :  dose,  2  to  6  dr.  Ammonias  benzoas :  dose,  10  to  20 
gr.  AmmonicB  sulphidum  (in  solution) :  dose,  3  min.  and  upwards  (sel- 
dom used:  dangerous  if  incautiously  given).  Ammonics  nitras :  used 
only  for  making  nitrous  oxide.  Ammonias  phosphas:  dose,  5  to  20  gr. 
freely  diluted.  Linimentum  ammonias  (with  olive  oil),  for  external  use. 
Compound  camphor  liniment  also  contains  ammonia  solution. 

[PREPARATIONS,  U.  S.  P. — Aqua  ammonias,  sp.  gr.  0.960;  Aqua  am- 
monias fortior,  sp.  gr.  0.900;  Linimentum  ammonias:  water  of  ammonia 
1  fluidounce,  olive  oil  2  troyounces;  Spiritus  ammonias, ;  Spiritus  am- 
monias aromaticus;  Liquor  ammonii  acetatis;  Ammonii  benzoas;  Am- 
monii bromidum;  Ammonii  carbonas;  Ammonii  chloridum;  Ammonii 
chloridum  purijicatum;  Ammonii  iodidum;  Ammonii  nitras;  Ammonii 
sulphas — used  in  preparations;  Ammonii  valerianas,  dose,  2  to  8  grains.] 


METALLIC  PREPARATIONS. 


ALUMIMUM  Al,=27-5. 

This  metal  has  not  been  found  native,  but  alumina,  its  oxide,  A12O, 
(known  also  as  argillaceous  earth),  is  widely  diffused  as  a  silicate  in  clay, 
slate,  granite,  etc.,  and  occurs  nearly  pure  in  the  sapphire  and  ruby.  The 
metal  itself  is  of  steel-gray  color  and  is  not  readily  oxidized:  sp.  gr.  2*67. 

Alumen,  the  officinal  alum,  NH4,A1,(SO4)812H,O,  is  a  double  sulphate 
of  alumina  and  ammonia  with  a  large  amount  of  water  of  crystallization: 
it  occurs  native  sometimes  in  mineral  waters,  and  in  efflorescence  on  stone. 
(There  are  many  similar  "alums,  "  or  double  sulphates  of  an  alkaline  base, 
and  a  metal:  thus  there  is  a  potash-alum^ — formerly  officinal,  but  more  ex- 
pensive than  ammonia-alum — a  soda-alum,  etc.  The  same  name  is  applied 
even  when  no  alumina  is  present,  as  to  the  double  sulphate  of  iron  and 
ammonia — iron-alum — and  to  similar  compounds  of  manganese  and  chro- 
mium.) 

PREPARATION. — The  officinal  alum  is  prepared  by  oxidation  of  alumin- 
ous schist,  sulphates  of  alumina  and  iron  being  formed  then  dissolved  in 
water,  and  treated  by  sulphate  of  ammonia:  on  concentrating  the  solution, 
alum  crystallizes  out. 

CHARACTERS  AND  TESTS. — Alum  crystallizes  in  octahedral,  sometimes 
in  cubic,  forms,  but  is  generally  met  with  in  irregular  lumps,  translucent 
and  colorless  when  fresh,  efflorescent  and  covered  with  small  crystals  after 
exposure.  It  has  an  acid  reaction  and  a  strongly  astringent,  subacid  taste; 
is  insoluble  in  alcohol,  soluble  in  eighteen  parts  of  cold,  and  half  its  weight 
of  boiling  water.  Heated,  it  dissolves  in  its  water  of  crystallization,  and 
when  this  has  been  driven  off,  alum  remains  as  a  dry,  white,  spongy  mass 
(alumen  exsiccatum  vel  ttstum — dried,  or  burnt  alum).  This  has  very 
astringent,  somewhat  caustic  properties;  it  readily  absorbs  moisture,  but 
is  sparingly  soluble:  heated  beyond  400°  F.  it  is  decomposed,  and  alumina, 
the  oxide,  A1SOS,  remains.  This  oxide  is  insoluble  in  water,  and  when 
alum  solutions  are  decomposed,  separates  as  precipitate;  hence  the  use  of 
alum  for  clearing  turbid  water,  for  when  it  is  added,  the  alkaline  and 
earthy  salts  present  in  the  water  combine  with  the  sulphuric  acid  of  the 


26C  MATERIA    MEDIC  A    AND    THERAPEUTICS. 

alum,  and  the  alumina  which  precipitates,  carries  with  it  most  of  the  im- 
purities present:  it  has  also  special  disinfecting  powers. 

The  acetate  of  alumina  (argilla  acetica),  the  chloride  (aluminium  chlo- 
ratum),  and  the  single  sulphate  (argilla  sulphurica),  though  not  officinal, 
are  in  occasional  use;  they  are  all  soluble  salts,  of  characteristic  styptic 
taste.  The  sulphate  has  been  found  native,  though  not  quite  pure;  it  is 
more  acid  than  the  ordinary  double  sulphate,  so  that  it  blunts  steel  instru- 
ments and  corrodes  linen. 

1.  The  bisulphide  of  ammonium  (NH4HS),  when  added  to  solution  of 
the  salts  of  aluminium  hydrate,  gives  a  white  gelatinous  precipitate  of 
ammonium  hydrate.  2.  The  caustic  alkalies  and  their  carbonates  give  a 
\vhiteprecipitate  with  aluminous  solutions,  soluble  in  excess  of  the  former. 
3.  Solutions  of  the  aluminous  salts  should  not  give  a  blue  color  on  the 
addition  of  ferrocyanide  and  ferricyanide  of  potassium,  showing  freedom 
from  iron.  4.  Alum,  when  heated  with  caustic  soda  or  potash,  evolves 
ammonia. 

ABSORPTION  AND  ELIMINATION. — Taken  into  the  mouth  alum  exerts 
the  local  action  presently  to  be  described,  and  its  first  sweetish  taste  is 
followed  by  a  peculiar  feeling  of  constriction,  and  abundant  flow  of  saliva: 
after  reaching  the  stomach,  combined,  more  or  less,  with  albumen,  some 
of  it  becomes  absorbed  though  slowly.  Orfila  detected  it  in  the  urine  and 
viscera  of  dogs  after  large  doses  (Annales  d' Hygiene  pub.,  i.,  235 — 9,v.), 
and  Krauss  found  the  urine  become  very  acid  under  itp  use.  The  greater 
part  of  the  alum  taken  combines  to  form  insoluble  compounds  with  the 
bile  and  other  organic  products,  and  is  eliminated  with  the  fasces.  It  is 
remarkable,  that  although  alumina  is  so  common  a  constituent  of  vegeta- 
ble food,  it  is  not  found  in  the  human  organism,  showing  how  completely 
it  passes  out. 

PHYSIOLOGICAL  ACTION  (EXTERNAL). — Alum  acts  as  a  typical  simple 
astringent,  contracting  the  arterioles  and  muscular  fibres  of  the  part 
touched  by  it,  and  rendering  the  surface  pale  and  dry.  It  combines  with 
albuminous  secretions  forming  whitish  flakes,  or  membranous  films,  in- 
soluble in  water,  but  soluble  in  acetic  and  hydrochloric  acids  (Mitscher- 
lich).  If  there  be  not  enough  fluid  present  to  saturate  the  alum,  it 
affects  the  deeper  tissues  in  a  somewhat  caustic  manner:  this  is  especially 
the  case  with  the  dried  salt.  Strong  or  long-continued  applications  ex- 
cite irritation  with  some  degree  of  inflammation,  and,  under  such  circum- 
stances, discharge  from  an  affected  part — e.g.,  the  conjunctiva,  or  the 
vaginal  mucous  membrane — may  be  increased  rather  than  diminished. 

The  acetate  of  alumina  and  chlor-aluminium  have  marked  disinfec- 
tant powers,  preserving  organic  tissue,  and  hindering  putrefaction. 
Burow  (185?)  found  that  the  acetate,  mixed  with  fresh  blood,  formed  a 
brown  syrupy  mass,  in  which  the  shape  of  the  corpuscles  was  not  retained, 
but  which  remained,  without  decomposing,  for  many  months.  Albumen, 


ALUMINIUM.  2G7 

treated  with  the  same  salt,  continued  clear,  and  did  not  coagulate  much 
on  boiling:  0.5  per  cent,  prevented  putrefaction  of  urine  an<j  of  meat, 
and  2  per  cent,  sterilized  bacteria. 

The  chloride  of  aluminium,  chlor-alum,  was  introduced  (mainly  by 
Mr.  John  Gamgee)  as  a  disinfectant  free  from  poisonous  or  corrosive 
properties;  it  not  only  prevents  decomposition,  but  removes  its  products 
by  absorbing  gas,  etc. :  it  serves  best,  perhaps,  for  the  disinfection  of 
closets,  drains,  etc. :  in  the  post-mortem  room  it  is  useful,  but  locally  ap- 
plied renders  the  muscular  tissue  pale  (Lund:  Medical  Times,  1873). 

PHYSIOLOGICAL  ACTION  (INTERNAL). — Digestive  System, — Small  doses 
(3  gr.)  taken  several  times  daily,  in  water,  cause  dryness  of  mouth  and 
throat,  thirst,  and  diminished  secretion  in  the  alimentary  canal,  the  stools 
being  rendered  harder  and  less  colored  than  normal  (Wibmer).  Doses 
of  10  gr.  disorder  the  digestion  by  lessening  the  gastric  secretion,  and 
from  15  to  60  gr.  cause  cramping  pain  and  nausea  (Barthez) :  2  to  3  dr. 
induce  vomiting  without  much  straining,  and  larger  continued  doses  may 
cause  colic  and  diarrhoea  with  considerable  increase  of  secretion  from  the 
intestinal  mucous  membrane. 

In  rabbits,  which  do  not  vomit,  2  dr.  proved  fatal,  with  evidence  of 
inflammation  and  erosion  of  the  stomach  (Mitscherlich).  To  dogs,  Orfila 
gave  1  to  2  oz.  without  other  marked  effect  than  vomiting,  though  if  a 
ligature  were  passed  round  the  oesophagus,  1  oz.  would  cause  death  in  a 
few  hours  (Devergie).  In  these  cases  the  gastric  membrane  was  found 
to  be  either  white  and  wrinkled,  almost  tanned,  or  was  distinctly  inflamed 
in  patches. 

Devergie  concluded  from  his  experiments  that  the  human  was  more  sen- 
sitive than  the  canine  stomach,  and  certainly  large  doses  of  1  to  2  oz.  cause 
in  man  much  burning  pain,  frothing  at  mouth,  vomiting,  purging  and  de- 
pression: the  symptoms  of  gastro-enteritis  may  develop  themselves,  but 
usually  the  emetic  action  gets  rid  of  the  drug  before  serious  injury  is  pro- 
duced. The  results  vary  somewhat  with  the  condition  of  the  stomach  at 
the  time,  for  at  a  trial  in  Paris  it  was  proved  that  a  lady,  the  subject  of 
chronic  dyspepsia,  took  about  20  gr.  of  burnt  alum  (by  mistake  for  gum 
arabic),  and  suffered  from  enteritis  in  consequence.  Orfila  gave  evidence 
that  such  a  result  was  due  to  exceptional  causes,  and  that  4  to  6  dr.  were 
often  given  without  inconvenience.  More  recently,  death  has  been  reported 
in  a  man  aged  fifty-seven  from  taking  13  dr.  of  burnt  alum:  he  suffered 
from  a  sensation  of  burning  and  constriction,  general  malaise  and  an- 
guish, hurried  respiration,  and  nausea  with  sanguineous  vomiting:  intel- 
ligence remained  good  (  Union  Medicale,  No.  64,  1873). 

Alum  was  at  one  time  largely,  and  even  now  is  to  some  extent  used 
in  the  adulteration  of  bread,  for  it  gives  a  whiter  color  to  the  flour.  In- 
jurious effects,  such  as  dyspepsia  and  constipation,  have  been  attributed 
to  it,  and  though  Christison  failed  to  notice  bad  results  from  any  amount 


208  MATERIA    AiEDICA   AND    THERAPEUTICS. 

that  came  under  his  notice,  I  have  myself  often  traced  indigestion  to  alum 
in  the  bre^ad:  it  would  certainly  follow  the  use  of  any  large  quantity. 
(It  may  be  noted  that  ordinary  natural  wheat  flour  would  give  about  4 
gr.  of  silicate  of  alumina  to  the  4-lb.  loaf,  and  the  determination  of  the 
amount  of  added  alum  has  been  a  frequent  puzzle  to  analysts. — Medical 
Times,  ii.,  1875.) 

THEORY  OF  ACTION. — We  are  not  yet  able  to  explain  exactly  the  man- 
ner in  which  alum  produces  its  effects,  though  doubtless  its  affinity  for 
water,  and  its  power  of  coagulating  albumen,  are  important  factors.  M. 
Mialhe  supposed  the  astringent  action  to  depend  upon  a  chemical  decom- 
position, viz.,  the  precipitation  of  alumina  by  the  alkaline  elements  of  se- 
cretions, or  of  blood;  and  he  further  supposed  that  the  secondary  effect  of 
increased  discharge — which  we  have  mentioned — was  due  to  an  absorption 
of  the  recently -formed  alumina  rendering  the  blood  more  fluid  (u.  Stille, 
vol.  i.).  This  chemical  explanation  is  not,  however,  satisfactory,  for  tak- 
ing only  the  latter  point,  astringent  effects  persist,  as  a  rule,  after  the 
absorption  of  any  ordinary  doses,  and  it  is  only  under  the  continuance  of 
large  doses  (1  to  2  oz.),  irritative  by  their  mere  mechanical  effects,  that 
discharge  is  increased;  such  increase,  therefore,  is  better  explained  as  a 
consequence  of  direct  local  irritation  than  of  fluidity  of  blood.  It  is  not 
uncommon  for  astringents — nitrate  of  silver,  for  example — in  dilute  solu- 
tion to  lessen  discharge,  and  when  more  concentrated  to  increase  it. 

SYNERGISTS. — Tannin,  sulphuric  acid,  and  astringents  generally,  favor 
the  action  of  alum,  and  are  often  combined  with  it;  but  as  tannin  de- 
composes alum,  it  seems  probable  that  if  given  in  the  same  mixture  or 
compound,  the  substances  may  really  prove  less  astringent  than  when 
given  separately. 

ANTAGONISTS — INCOMPATIBLES. — If  an  over-dose  of  alum  be  taken, 
mucilaginous  and  albuminous  liquids,  such  as  milk  with  white  of  egg,  or 
gum  arabic,  or  fluid  glue,  should  be  freely  given.  Magnesia  should  be 
added,  according  to  v.  Hasselt,  or  carbonate  of  ammonia  in  small  quanti- 
ties (Taylor).  Alkalies  and  their  carbonates,  and  acetate  of  lead,  are 
chemically  incompatible  with  alum. 

THERAPEUTICAL  ACTION  (EXTERNAL). — Alum  is  one  of  the  oldest 
known  remedies,  and  was  often  prescribed  by  Hippocrates  and  Celsus: 
its  properties,  as  already  described,  render  it  unsuitable  for  the  acute 
stages  of  any  active  inflammation,  but  most  useful  in  many  chronic  ca- 
tarrhal  conditions,  and  relaxed  states  of  mucous  membrane. 

Skin  Diseases,  etc. — In  some  forms  of  discharging  skin  disease,  such 
as  chronic  eczema,  an  alum  lotion  of  moderate  strength  (1  dr.  to  6  or  8 
oz.)  will  act  favorably  as  an  astringent;  it  is  also  useful  if  sponged  over 
the  surface  in  profuse  or  exhausting  perspirations.  On  indolent  sores 
and  fungous  granulations  the  powder  may  be  sprinkled,  opium  being 
added,  if  desirable,  to  lessen  the  pain  that  may  be  caused:  this  combina- 


ALUMINIUM.  269 

tion,  combined  with  catechu,  has  also  been  praised  in  hospital  gangrene. 
The  "  lapis  divinus,"  which  is  prepared  with  equal  parts  of  alum,  blue 
stone,  and  nitre,  fused  together,  is  a  stimulant  application  to  ulcerated 
and  discharging  surfaces,  much  used  on  the  Continent,  and  compounds 
of  alumina  have  lately  proved  very  serviceable  as  disinfectant  and  altera- 
tive dressings. 

The  acetate  of  alumina,  and  the  double  sulphate  of  alumina  a^d  zinc, 
have  been  specially  recommended  in  lotion  for  foatid  perspiration  and  ul- 
ceration.  Thorey  prescribed  the  chloride  for  diphtheritic  and  gangrenous 
sores,  though  others  report  it  unduly  irritating. 

For  antiseptic  surgery  Professor  Maas  and  Dr.  Pinner  have  recently 
reported  favorably,  after  extensive  trial,  of  alumina  acetate  (Berlin. 
Klin.  Woch.,  12-13,  1880,  and  Medical  Times,  i.,  1880).  Since  the  salt 
is  not  stable  as  a  solid,  they  make  a  solution  of  1,000  parts  of  "  colloidal 
alumina  "  in  800  parts  of  dilute  acetic  acid  (thus  giving  a  proportion  of 
about  15  per  cent.)  for  preparing  an  antiseptic  gauze,  which  is  cheaper 
than,  and  quite  as  efficient  as,  the  carbolic.  For  the  spray,  a  strength  of 
2£  per  cent,  is  chosen;  this  is  strong  enough  to  lessen  hemorrhage,  and 
does  not  anaesthetize  the  hands:  for  washing  the  skin  and  the  instru- 
ments, carbolic  solutions  are  still  retained. 

Stomatitis,  etc. — When  small  ulcerations  occur  in  the  buccal  mucous 
membrane,  and  when  there  is  gingivitis  or  sponginess  and  inflammation 
of  the  gums,  dried  alum,  applied  in  the  form  of  powder,  or  a  lotion  con- 
taining it  with  myrrh  and  spirits  of  wine,  is  very  useful.  Salivation  is 
also  restrained  by  its  moderate  use,  and  injurious  effects  on  the  gums 
during  a  mercurial  course  may  be  prevented  by  keeping  a  piece  of  alum 
in  the  mouth  for  a  few  minutes  occasionally.  At  Aix-la-Chapelle,  pa- 
tients are  ordered  to  use  alum  gargles  and  washes  frequently  during  the 
mercurial  treatment. 

Toothache  dependent  on  caries  may  often  be  cured  by  the  local  use  of 
a  paste  made  with  alum,  ether,  and  mucilage,  which  should  be  applied 
until  the  sensitive  nerve  is  destroyed  (Legaulon). 

In  Catarrhal  Angina  and  "  relaxed  throat,"  especially  for  relaxed 
uvula,  the  gargle  of  Riviere  (1  dr.  of  alum  to  6  oz.  of  water)  is  still  a  fre- 
quent prescription.  It  is  said,  however,  to  be  injurious  to  the  teeth,  and 
plain  water  should  be  used  after  it. 

In  Hoarseness,  a  gargle  containing  2  dr.  of  alum  in  6  oz.  of  barley 
water  has  been  found  useful  for  professional  singers  (Bennati):  the  re- 
medy is  still  better  applied  in  the  form  of  spray  (10  gr.  to  1  oz.). 

Tonsillitis. — In  early  stages  even  of  acute  tonsillitis,  insufflation  of 
very  finely-powdered  alum,  or  warm,  weak  alum  gargles  will  often  assist 
in  cutting  short  the  attack,  but  if  this  be  fully  developed  before  treat- 
ment is  commenced,  alum  would  be  more  likely  to  irritate  than  to  relieve: 
its  use  is  better  reserved  for  chronic  congested  conditions,  with  or  with- 


270  MATERIA    MEDICA    AND    THERAPEUTICS. 

out   spots  of   ulceration,  when  the  fine  powder  should  be  gently  blown 
over  the  affected  part  through  a  quill  or  suitable  tube. 

In  Purulent  Ophthalmia,  as  occurring  especially  in  children,  an  alum 
lotion  containing  4  to  6  gr.  to  the  ounce  is  very  useful  when  properly 
applied:  it  should  be  used  very  frequently,  every  half-hour  or  hour,  in  a 
gentle  stream,  so  as  to  thoroughly  cleanse  the  lids,  and  in  addition  drops 
of  a  wo^k  solution  of  nitrate  of  silver  may  be  required  once  daily:  this 
method  is  the  most  relied  upon  at  the  London  Ophthalmic  Hospital 
(Medical  Times,  ii.,  1873). 

In  Gonorrhceal  Ophthalmia,  and  in  the  severe  ophthalmiee  of  Egypt 
and  India,  similar  frequent  use  of  alum  lotions  is  also  serviceable.  My 
colleague,  Mr.  Macnamara,  has  seen  cases  cured  in  the  latter  country  by 
applying  round  the  orbit  a  mixture  of  burnt  alum  with  lemon-juice. 

In  Catarrhal  Conjunctivitis  and  Chemosis,  a  convenient  and  useful 
application  is  the  alum  curd,  made  with  boiling  milk,  or  the  alum  "  poul- 
tice," prepared  by  rubbing  a  little  of  the  powder  with  white  of  egg  till  a 
coagulum  is  formed;  this  is  placed  between  two  layers  of  thin  cambric 
and  applied  over  the  closed  lids. 

Otorrhcea —  Ozaena. — In  sub-acute  or  chronic  stages  of  otorrhoaa,  an 
alum-injection  of  the  strength  already  mentioned — 4  to  6  gr.  to  the  ounce 
— is  cheap,  and  often  effective  :  its  use  should  be  preceded  by  a  douche 
of  plain  water,  otherwise  the  alum  will  be  prevented  by  coagulated  secre- 
tion from  directly  reaching  the  affected  membrane.  The  remedy  should 
not  be  continued  too  long,  or  it  may  excite  irritation. 

In  chronic  ozsena  (offensive  nasal  discharges),  a  douche  of  double  or 
treble  strength  may  be  used.  Homolle  has  recommended  the  single  sul- 
phate as  a  better  remedy  for  this  disorder,  and  others  have  preferred  the 
chloride  (chloralum)  or  acetate. 

Nasal  Polypi  have  sometimes  been  cured,  or  greatly  relieved  by  the 
insufflation  of  finely  powdered  alum,  or  strong  alum  solution. 

Leucorrhwa — Gonorrhoea. — Injections  of  alum  alone,  or  combined 
with  zinc  or  oak-bark,  are  often  used  with  advantage,  especially  in  leu- 
corrho3al  discharges:  a  strength  of  about  5  gr.  to  the  ounce  is  usually 
sufficient,  and  plain  water  should  be  first  injected  to  cleanse  the  surface. 
In  the  early  acute  stages,  as  already  mentioned,  alum  is  not  suitable,  and 
at  any  time,  too  strong  a  solution  applied  to  the  vagina  may  cause  irrita- 
tion and  cramping  pain. 

Prolapsus. — Leucorrhoea  is  commonly  accompanied  by  a  relaxed  con- 
dition of  vaginal  mucous  membrane,  which  is  also  amenable  to  alum.  A 
good  method  of  using  it  is  to  place  a  sponge,  soaked  in  its  solution,  well 
within  the  vagina  for  several  hours;  this  will  often  relieve  the  slighter 
forms  of  prolapsus  uteri.  Rectal  prolapsus  should  be  bathed  with  alum 
water  before  being  returned,  and  afterward  an  injection  of  the  same 
should  be  practised. 


ALUMINIUM.  271 

The  severe  Pruritus  and  burning  about  the  vulva  and  the  anus,  often 
associated  with  leucorrhcea  and  prolapsus,  may  be  equally  relieved  by 
strong  alum  solutions. 

In  the  Vulvitis  of  children,  Dr.  Ringer  regards  alum  as  one  of  the 
best  remedies,  recommending  a  solution  of  1  dr.  to  the  pint  of  water,  to 
be  applied  constantly,  and  injected  occasionally. 

Excoriations  of  Cervix  Uteri. — The  local  application  of  alum  was,  at 
one  time,  much  praised  in  this  condition  (Delmas:  British  and  Foreign 
Review,  July,  1841). 

Chronic  Catarrhal  Cystitis. — This  obstinate  disorder  may  be  often 
relieved  by  the  use  of  a  weak  alum-injection — 10  gr.  in  the  pint:  the 
bladder  should  be  first  washed  out  with  warm  water,  so  as  to  avoid  the 
clotting  of  discharge. 

I  have  known  vesical  pain  and  frequency  of  micturition  quickly  re- 
lieved by  such  injections,  which  have  been  followed  also,  in  several  in- 
stances, by  marked  diminution  of  the  thick,  gelatinous,  ropy  mucus 
commonly  secreted  in  this  malady:  the  alkaline  reaction  and  acrid  am- 
moniacal  odor  of  urine  have  been  removed  at  the  same  time.  The  last- 
named  conditions  may  be  dependent  sometimes  on  the  introduction  of 
low  organisms  by  a  soiled  catheter  (Traube,  Niemeyer),  but  even  in  such 
cases,  alum-injections  are  equally  useful  by  their  antiseptic  properties. 
Blockley  and  Parkington  specially  recommended  the  single  sulphate  for 
vesical  and  vaginal  catarrh. 

Hemorrhage — Epistaxis,  etc. — Alum  is  serviceable  applied  externally 
in  cases  of  bleeding  from  superficial  vessels,  as  from  the  surface  of 
wounds  or  mucous  membranes,  e.g.,  of  the  nose  or  of  the  vagina,  from 
haemorrhoids,  from  leech-bites,  or  after  tooth-extraction:  in  such  cases  it 
may  be  used  in  substance,  a  pointed  plug  or  the  fine  powder  being  firmly 
pressed  on  the  part,  or  a  compress  steeped  in  a  strong  warm  solution 
may  be  allowed  to  cool  upon  it.  Such  applications  condense  the  tissues 
and  contract  the  vessels,  but  it  should  be  borne  in  mind  that  if  too  strong 
or  too  prolonged,  they  may  give  rise,  especially  in  scrofulous  subjects, 
to  unhealthy  ulceration.  The  alum  powder  is  sometimes  combined  with 
zinc  sulphate,  or  diluted  with  starch  or  sugar,  and  the  solution  may  be 
made  with  decoction  of  logwood.  Combined  with  benzoin  and  alcohol, 
it  forms  a  celebrated  styptic  and  antiseptic,  the  "Aqua  Pagliari"  (ben- 
zoin, 100  gr.,  alcohol,  £  oz. ;  dissolve  and  add  water,  £  pint;  alum,  1  oz. ; 
boil  till  clear,  then  filter).  The  solution  of  Mentel  is  similar,  but  made 
with  the  single  sulphate. 

THERAPEUTICAL  ACTION  (INTERNAL). — The  internal  use  of  alum  is 
combiiied  with  its  external  application  in  many  varieties  of  hemorrhages, 
though  it  is  not  depended  upon  so  much  now  as  formerly:  it  is  best 
suited  for  cases  of  "  passive  hemorrhage,"  with  relaxed  condition  of  mu- 
cous membrane,  and  when  no  acute  inflammation  is  present. 


272  MATERIA    MEDIC  A   AND    THERAPEUTICS. 

In  Hcemoptysis,  tubercular  or  otherwise,  when  moderate  but  persist- 
ent, it  is  a  good  adjuvant  to  other  remedies,  e.g.,  sulphuric  acid.  Skoda 
commonly  gave  10-gr.  doses  with  Dover's  powder.  A  spray  containing 
the  same  quantity  in  1  oz.  of  water  may  be  used  with  advantage  at  the 
same  time. 

In  Bleeding  from  the  Stomach  or  bowels — dependent  as  these  symp- 
toms often  are  upon  cirrhosis,  and  when  passive  and  atonic  in  character 
— alum  may  be  a  suitable  remedy;  its  astringent  effect  in  such  cases  is, 
in  part,  at  least,  direct  and  local. 

In  Menorrhagia  Cullen  specially  commended  alum,  and  it  is  still  used 
more  frequently  perhaps  in  this  flux  than  in  any  other.  In  the  form  of 
"alum  whey,"  which  is  prepared  by  boiling  2  dr.  of  the  powder  with  1 
pint  of  milk,  straining  off  the  curd,  and  adding  sugar,  it  is  a  not  unpleas- 
ant medicine,  of  which  a  wineglassful,  three  or  four  times  daily,  will  gen- 
erally control  the  discharge — according  to  my  own  observation. 

Iloematuria. — In  bleeding  from  the  kidneys,  alum  whey  is  also  use- 
ful, but  "  iron  alum "  (double  sulphate  of  iron  and  ammonia)  is  a  still 
more  active  remedy,  which  has,  in  my  experience,  acted  better  than  many 
others.  In  cases  where  blood  comes  from  the  mucous  membrane  of  the 
bladder  or  urethra,  and  when  pain,  straining,  and  undue  frequency  of 
micturition  are  present,  I  have  known  speedy  benefit  follow  the  use  of 
alum  injections  (20  gr.  to  the  pint)  into  the  bladder. 

Albuminuria. — The  drain  of  albumen  in  Bright's  disease  is  practi- 
cally equivalent  to  a  loss  by  hemorrhage,  and  it  has  been  sometimes  re- 
strained by  the  use  of  alum:  thus,  Oppolzer  and  Heller  have  reported 
benefit  from  it  in  chronic  cases  (quoted  by  Dr.  W.  Roberts),  but  after 
repeated  trials  I  have  not  been  able  to  verify  their  good  results. 

Diabetes. — In  diabetes  insipidus,  or  "  polyuria,"  when  there  is  an  ex- 
cessive flow  of  limpid  but  non-saccharine  urine,  alum  deserves  further 
trial,  though  the  malady  is  anomalous  and  often  is  uncontrolled  by  any 
remedies.  In  true  diabetes  a  partial  and  temporary  benefit  has  been  de- 
rived by  some  patients  for  whom  I  have  prescribed  it. 

Gastric  Catarrh. — In  cases  with  vomiting  of  glairy  mucus,  alum  is  a 
cheap  and  efficient  remedy.  Sir  J.  Murray,  one  of  the  principal  advocates 
for  its  use,  pointed  out  that  it  acted  better  when  given  in  substance  than 
in  solution:  thus  a  pill  with  gentian  extract  is  a  good  form,  or  an  electuary 
with  honey. 

Diarrhoea. — I  have  found  alum  very  useful  in  infantile  diarrhoea  when 
arising  from  errors  in  diet,  and  attended  with  vomiting,  acidity,  and  green 
stools:  from  1  to  5  gr.  may  be  given  with  syrup.  Diarrhoea  dependent 
upon  relaxed  conditions  of  mucous  membrane  is  also  cured  by  alum. 
Fouquier  and  others  have  praised  it  in  enteric  fever  (Bulletin  de  Thera- 
peutique,  ix.,  p.  301),  but  it  is  not  easily  taken,  and  it  is  liable  to  irritate, 
so  that  other  remedies  are  usually  to  be  preferred.  Alumina,  or  argilla 


ALUMINIUM.  273 

pura,  is  placed  in  the  Austrian  Pharmacopoeia  as  an  antacid  remedy  for 
diarrhoea,  especially  in  children,  and  is  used  like  bismuth  salts.  Barthez 
recommends  the  single  sulphate  as  preferable. 

Dysentery. — Moseley,  in  his  work  on  tropical  diseases,  considers  alum 
to  be  one  of  the  best  medicines  in  acute  and  chronic  dysentery,  and  Dr. 
Waring  has  often  seen  it  useful  in  asthenia  cases;  it  was  commonly  given 
with  opium.  I  think  that  a  good  mode  of  administering  it  in  chronic 
cases  is  by  injection,  from  10  gr.  to  2  dr.  in  a  pint  of  liquid  being  used  at 
a  time  (Hannon:  Bulletin  deF  Academic,  xxxil);  this  will  also  relieve  the 
troublesome  tenesmus,  and  the  sense  of  itching  and  excoriation  about  the 
anus.  One  drachm  to  the  pint  is  a  proportion  I  have  commonly  used 
twice  daily  with  good  success:  a  strength  of  £  oz.  to  the  pint  has  also 
been  used,  but  caused  some  burning  pain;  improvement,  however,  soon  be- 
gan, and  cure  resulted  after  about  fourteen  days  of  treatment  (Medical 
Itecord,  1879). 

Constipation. — Besides  the  astringent  power  exerted  by  5  to  10-gix 
doses  of  alum,  we  must  notice  the  irritant  effect  of  larger  quantities,  by 
which  probably  they  become  useful  in  constipation.  Alum  is  seldom, 
to  be  preferred  to  other  remedies  for  this  disorder,  though  it  rnay  act 
favorably  in  atonic  cases,  when  the  muscular  coat  of  the  bowel  is  deficient 
in  power,  and  when  mucous  secretion  is  scanty.  Mr.  Aldridge  has  pub- 
lished reports  illustrating  the  good  effect  of  20  to  40  gr.  daily  in  produc- 
ing copious  and  solid  evacuations;  he  also  associated  it  with  sulphate  of 
magnesia  (Braithwaite,  vol.  xii.).  Such  treatment,  however,  is  rarely 
worth  trial,  and  my  own  experience  with  it  is  not  favorable;  it  either  in- 
creased constipation  or  caused  dysenteric  symptoms. 

Lead  Colic. — In  this  common  and  painful  malad}r,  which  is  always 
accompanied  by  obstinate  constipation,  there  is  much  evidence  of  the 
virtue  of  alum,  dating  from  the  last  century.  Dr.  Copland  praises  it,  and 
M.  Brachet  of  Lyons,  writing  from  a  large  experience,  awards  to  it  the^ 
first  place  among  remedies:  for  eight  years  he  states  that  the  treatment 
he  employed  consisted  of  emetics  and  purgatives,  then  he  gave  a  trial  to 
antiphlogistics,  and  then  to  opiates:  lastly,  influenced  by  the  success  of' 
Gendrin,  he  commenced  to  give  1£  to  2  dr.  of  alum  daily  in  mucilaginous; 
liquid,  and  either  with  or  without  laudanum;  on  the  third  day  usually 
the  bowels  acted,  and  if  not,  an  aperient  was  given  and  the  patient  was. 
nearly  or  quite  cured,  and  this  in  upward  of  150  cases.  The  successful 
cases  of  M.  Gendrin  were  fifty-eight  in  number,  and  he  experienced  no. 
failures  with  the  alum  treatment. 

In  considering  how  it  may  operate,  it  is  curious  to  notice  the  different 
views  that  have  prevailed  as  to  the  pathology  of  the  malady.  M.  Baumes, 
Mialhe,  and  others,  consider  it  a  general  poisoning  of  the  system;  Com- 
balusier  limits  the  poisoning  to  the  primse  vise;  Cullen,  Vogel,  and  others, 
make  the  colic  a  nervous  affection,  Willis  refers  it  to  the  brain,  Serre  to. 
Voi*  L— 18 


274  MATERIA   MEDICA    AND    THERAPEUTICS. 

the  spinal  cord;  Orfila  and  Grisolle  consider  it  a  lesion  of  the  abdominal 
nerves,  or  the  great  sympathetic,  while  Bracher  and  Andral  trace  it  to 
lesion  both  of  cerebro-spinal  and  ganglionic  nerve-centres. 

The  intestines  have  been  most  generally  regarded  as  the  seat  of  dis- 
ease, either  in  all  their  structure  or  in  their  mucous  or  their  muscular 
coat.  Meral  especially  argues  that  the  latter  is  in  a  state  of  paralysis,  a 
conclusion  which  has  been  widely  accepted,  and  alum  has  been  supposed 
to  act  partly  as  a  stimulant  to  the  paralysed  muscle,  and  partly  as  a 
direct  chemical  antidote  to  the  lead  which  it  converts  into  an  insoluble 
sulphate.  In  support  of  this  view  it  may  be  mentioned  that  other  sul- 
phates, as  of  magnesia,  soda,  zinc,  and  free  sulphuric  acid  also  act  favor- 
ably; but  it  scarcely  explains  the  quick  relief  that  is  sometimes  given, 
and  one  cannot  say  that  its  mode  of  action  is  quite  clear.  It  would  seem 
to  have  a  specific  power  of  relieving  pain,  because  it  has  proved  useful  in 
other  varieties  of  gastralgia  and  colic  (Dr.  Griffin,  on  Spinal  Irritation, 
etc.). 

I  have  myself  only  witnessed  the  good  effects  of  the  drug  in  two  cases 
of  lead-poisoning  which  presented  all  the  usual  symptoms:  it  relieved  the 
pain  and  terminated  the  constipation;  from  10  to  20  gr.  may  be  given 
every  two  hours,  properly  diluted,  and  this  quantity  may  be  increased 
to  1  dr.  or  more,  if  necessary.  Sulphuric  acid  and  syrup  of  lemon  form 
a  suitable  vehicle  for  it:  in  some  cases  it  is  well  combined  with  a  little 
opium. 

On  the  other  hand,  several  good  authorities  report  less  favorably  of 
the  remedy :  Tanquerel  and  Grisolle  found  it  almost  inert,  and  Brown  re- 
cords increase  of  pain  and  of  constipation  from  its  use.  Husemann,  who 
may  be  taken  as  representing  the  German  school,  speaks  of  it  as  "  ob- 
solete," but  with  us  it  certainly  is  not  so;  Dr.  Bartholow,  for  instance,  in 
his  recent  treatise,  describes  it  as  "  most  effective  "  in  the  relief  of  the 
pain,  the  vomiting,  etc. 

Emetic  Action —  Croup. — Besides  its  astringent  and  stimulating  power, 
alum,  in  doses  of  about  1  dr.,  is  a  very  useful  emetic,  because  it  is  prompt 
in  action,  and  does  not  depress  the  system:  hence  it  has  been  recommended 
in  croup  both  to  dislodge  the  false  membrane  and  hinder  its  re-formation; 
it  may  be  repeated  every  quarter  of  an  hour  for  several  doses.  Narcotic 
poisoning  has  also  been  treated  by  it. 

Whooping- Cough. — In  the  chronic  stages  of  this  complaint,  where 
secretion  is  profuse  and  spasm  severe,  and  there  is  not  much  complicating 
bronchitis  or  pyrexia,  I  have  seen  alum  exert  a  very  beneficial  influence: 
4  to  10  gr.  in  water  or  syrup  should  be  given  three  or  four  times  daily. 
Dr.  Golding  Bird  introduced  and  highly  commended  this  treatment,  con- 
joining the  alum  with  conium  and  dill-water.  Dr.  Meigs  states  that  alum 
has  given  him,  in  sixty-eight  cases,  better  results  than  any  other  remedy 
(Diseases  of  Children).  Its  good  effect  may  be  traced,  probably,  to  a  lo- 


ANTIMONY.  275 

cal  astringent  action  on  the  fauces;  hence  it  is  best  administered  in  some 
thick  vehicle,  and  swallowed  slowly. 

Asthma — Bronchitis. — It  is  said  that  a  paroxysm  of  asthma  may 
sometimes  be  prevented  by  placing  about  10  gr.  of  alum  on  the  tongue 
(Ringer).  In  bronchitis,  5  to  10  gr.,  given  every  four  hours,  serve  to  fa- 
cilitate expectoration,  and  at  the  same  time  its  amount  is  restrained  and 
dyspnoea  relieved.  Moseley  praised  this  use  of  alum  many  years  ago,  and 
advised  it  both  for  acute  and  chronic  forms  with  viscid  ropy  expectora- 
tion; but  it  is  in  these  latter  cases  only  that  I  should  consider  it  suitable. 

PREPARATIONS  AND  DOSE. — Alumen:  dose  as  an  astringent,  10  to  20 
gr. ;  as  &  purgative,  30  to  60  gr.  or  upwards;  as  an  emetic,  1  dr.  to  1  oz. 
In  lead  colic,  20  to  120  gr.  have  been  given  in  the  twenty-four  hours. 
Alumen  exsiccation  :  the  dose  should  be  somewhat  less,  and  practically 
this  preparation  should  be  kept  for  external  use  only.  The  solid  drug 
seems  to  be  more  effectual  than  the  liquid  form;  it  may  be  given  in  pill 
or  in  confection  with  sugar,  honey,  or  molasses:  cream  of  tartar  may  be 
added,  if  necessary,  to  obviate  constipation,  and  cinnamon  or  other  aro- 
matics  to  prevent  flatulence.  The  "  fills  of  Helvetius"  formerly  cele- 
brated, contained  3  gr.  mixed  with  "dragon's  blood;"  a  more  modern 
formula  is  with  gentian,  rhubarb,  etc. 

In  solution  it  may  be  given  with  sweetened  aromatic  water  or  muci- 
lage, or  sulphuric  acid  and  syrup  of  lemons  may  be  added;  or  an  "alum 
whey  "  may  be  made  by  stirring  2  dr.  of  the  powder  with  a  pint  of  boiling 
milk,  straining,  and  adding  sugar. 

For  a  cottyrium,  a  strength  of  5  gr.  to  the  ounce  of  rose  water  is  suit- 
able: for  a  gargle  from  8  to  20  gr.  in  the  ounce:  for  a  lotion  or  injection 
it  may  be  well  combined  with  zinc  sulphate,  as  in  the  liq.  aluminis  co.  (L. 
P.),  which  was  ordered  with  1  oz.  of  each  salt  to  3  pints  hot  water.  Oint- 
ment: 12  to  24  gr.  to  the  ounce  of  simple  ointment.  Liniment:  with 
white  of  egg  and  camphorated  spirit  (for  bedsore). 

[PREPARATIONS,  U.  S.  P. — Alumen — Same  as  that  of  the  Br.  Pharma- 
copeia; Aluminii  et  potassii  sulphas,  the  common  alum  of  the  shops; 
Aluminii  sulphas.] 


ANTIMONIUM— ANTIMONY—  STIBIUM,  Sb, = 122. 

This  substance,  which  is  now  classed  among  metalloids,  occurs  native, 
but  in  small  quantities.  It  is  usually  found  in  alloy  with  various  metals, 
chiefly  iron,  lead,  and  arsenic,  and  from  these  its  purest  commercial  sam- 
ples are  seldom  quite  free.  Traces  of  it  occur  also  in  some  chalybeate 
waters,  and  its  oxide  constitutes  the  "white  antimony  ore  "  (valentinite): 
its  most  common  ore  is  the  sulphide,  from  which  crude  antimony  is  ob- 
tained by  fusion  with  iron,  or  by  roasting  and  reduction  with  charcoal. 


276  MATERIA    MEDIOA    AND    THERAPEUTICS. 

When  pure,  it  is  silvery  white  in  color  with  a  tinge  of  blue,  laminated 
in  structure,  brittle,  and  crystalline;  it  is  heavy  (sp.  gr.  6.7)  and  perman- 
ent in  the  air  at  ordinary  temperature.  In  its  chemical  relations  it  is  allied 
to  nitrogen  and  phosphorus,  and  still  more  closely  to  arsenic. 

COMPOUNDS  OF  ANTIMONY. 

ANTIMONIUM  NIG  RUM— BLACK  ANTIMONY,  SbsS,,=340. 

PREPARATION. — From  the  native  ore  stibnite,  by  fusing  and  then  re- 
ducing to  a  fine  powder. 

CHARACTERS  AND  TESTS. — A  crystalline  steel-gray  metallic-looking 
powder,  which  dissolves  in  boiling  hydrochloric  acid,  with  evolution  of 
sulphuretted  hydrogen. 

ANTIMONIUM  SULPHURATUM— SULPHURATED  ANTIMONY, 

SbjS3,  Sb.Oi.  « 

(Golden  or  precipitated  sulphuret,  an  oxy-sulphide). 

PREPARATION. — By  dissolving  the  black  sulphide  in  caustic  soda  with 
the  aid  of  heat,  and  adding  sulphuric  acid;  several  complex  reactions  oc- 
cur, and  sulphurated  antimony  is  precipitated. 

CHARACTERS  AND  TESTS. — An  orange-red  powder,  inodorous,  almost 
tasteless,  insoluble  in  water,  soluble  in  hydrochloric  acid,  also  in  solutions 
of  caustic  alkali,  and  of  acid  tartrate  of  potash:  exposed  to  light  and  air 
it  partially  decomposes,  with  separation  of  sulphur. 

There  are  several  other  reddish  or  brown  oxy-sulphides  of  antimony, 
and  all  have  been  termed  "  kermes  mineral,"  from  some  resemblance  in 
color  to  the  insect  kermes  (cochineal). 

ANTIMONII  CHLORIDI  LIQUOR— SOLUTION  OF  CHLORIDE  OF 
ANTIMONY,  SbCl3,  =228.5. 

PREPARATION. — By  dissolving  black  antimony  in  hydrochloric  acid. 

CHARACTERS  AND  TESTS. — A  heavy,  yellowish-red  liquid,  which,  when 
poured  into  water,  gives  a  dense  white  precipitate  of  oxy-chloride  (SbOCl). 

The  pure  chloride,  which  may  be  obtained  by  distillation,  is  volatile, 
but  concretes,  on  cooling,  into  a  soft,  white  solid,  "butter  of  antimony /" 
and  this  term  is  sometimes  given  to  the  officinal  solution. 

ANTIMONII  OXIDUM— OXIDE  OF  ANTIMONY,  SbJO,,=292. 

PREPARATION. — By  decomposing  the  oxy-chloride  with  sodic  carbon- 
ate. 

CHARACTERS  AND  TESTS. — A  grayish-white  powder,  inodorous,  taste- 


ANTIMONY.  277 

less,   and  insoluble  in  water,  soluble  in  hydrochloric  acid:   moderately 
heated,  it  turns  yellow,  at  a  red  heat  it  burns,  or  sublimes  in  crystals. 


ANTIMONIUM  TARTARATUM—TARTARATED  ANTIMONY— TAR- 

TRATE  OF  ANTIMONY  AND  POTASH— TARTAR  EMETIC, 

KSbC<H407HaO, =343. 

PBEPARATION. — By  mixing  the  oxide  of  antimony  with  acid  tartrate 
of  potash  and  water  for  twenty-four  hours,  afterward  boiling  in  water, 
and  crystallizing  out. 

CHABACTEBS  AND  TESTS. — Occurs  in  rhombic,  octahedral,  colorless 
crystals,  transparent  when  fresh,  but  efflorescing  on  exposure  to  air; 
also,  and  more  frequently,  in  the  form  of  powder,  which  should  be  per- 
fectly white,  a  yellowish  tinge  indicating  the  presence  of  iron.  It  is 
odorless,  but  has  a  sweetish,  subacid  taste,  which  quickly  becomes  metal- 
lic and  nauseous,  but  may  not  be  much  noticed  if  the  powder  be  largely 
diluted.  The  crystals  are  best  obtained  for  microscopic  examination  by 
evaporating  on  a  slide  a  drop  of  the  hot  solution:  characteristic  triangu- 
lar facets  are  seen,  and  some  modifications  of  the  cube,  and  they  are  larger 
than  arsenical  crystals:  branched  crystalline  forms  also  occur,  as  in  many 
other  saline  solutions.  The  crystals  of  tartar  emetic  are  isorcorphous 
with  those  of  the  sulphate  of  potash,  but  the  latter  do  not  effloresce. 
Tartar  emetic  is  soluble  in  two  parts  of  boiling,  and  in  fourteen  parts  of 
cold  water;  less  soluble  in  proof  spirit,  or  in  wine,  and  insoluble  in  abso- 
lute alcohol.  Acids,  except  tartaric  acid,  occasion  a  white  precipitate, 
as  also  do  alkalies,  alkaline  earths,  and  their  carbonates,  but  excess  of 
these  agents  will  re-dissolve  the  precipitates. 

The  dried  salt,  like  other  tartrates,  decrepitates  and  chars  on  the  ap- 
plication of  heat,  and  its  solution  in  water  readily  becomes  mouldy  from 
the  development  of  a  fungus  (a  little  added  spirit  will  prevent  this). 

Infusion  of  galls,  catechu,  cinchona,  strong  tea,  or  tannin  in  any  form, 
precipitate  a  tannate  of  antimony,  which  is  so  insoluble  as  to  be  practi- 
cally inert.  The  following  tests  are  applicable  to  any  soluble  antimonial 
salt: — (1)  If  it  be  boiled  in  water  with  one-sixth  part  of  pure  hydrochlo- 
ric acid  and  a  strip  of  metallic  copper,  antimony  will  be  deposited  on  the 
metal,  violet-red  in  color  if  the  quantity  be  small,  but  iron-gray,  or  black, 
if  in  large  amount.  (2)  A  solution  acidulated  with  the  same  acid  (^th) 
gives,  in  the  cold,  a  black  deposit  on  pure  tin.  (3)  Sulphide  of  ammo- 
nium, or  sulphuretted  hydrogen,  produces,  in  acid  solutions,  an  orange- 
colored  deposit  soluble  in  hydrochloric  acid  (boiling),  and,  if  this  latter 
solution  be  poured  into  water,  a  white  deposit  of  oxide  occurs.  (4)  Evo- 
lution of  nascent  hydrogen  (as  from  zinc  and  sulphuric  acid)  in  the  pres- 
ence of  antimony,  leads  to  the  formation  of  antimoniuretted  hydrogen: 


278  MATEKIA   MEDIC  A    AND    THERAPEUTICS. 

this  burns  with  a  blue  flame,  and  produces  on  porcelain  a  black  stain 
which  is  insoluble  in  bleaching  powder. 

ABSORPTION  AND  ELIMINATION. — Soluble  compounds  of  antimony, 
such  as  tartar  emetic,  are  readily  absorbed,  especially  by  mucous  mem- 
branes, and  they  circulate  in  the  blood,  either  unchanged  or  as  albumi- 
nates.  The  infant  at  the  breast  may  be  affected  by  them  through  the 
mother,  and  they  may  be  detected  in  the  different  secretions  during  life, 
and  in  the  viscera,  especially  the  liver,  kidneys,  and  intestines,  after  death. 

The  degree  of  absorption  naturally  varies  with  the  preparation  used, 
the  dose,  and  the  state  of  the  stomach.  Metallic  Antimony  in  powder, 
the  oxide,  and  the  sulphuret  are  absorbed  to  some  extent,  but  much  less 
freely  than  the  potassio-tartrate,  which  is  itself  more  completely  ab- 
sorbed, and  acts  more  powerfully,  if  acid  wines  or  fruits  are  taken  at  the 
same  time  (Trousseau).  Large  doses  are  usually  vomited  soon,  and  be- 
fore much  absorption  has  occurred;  but  if  taken  with,  or  shortly  after, 
food  vomiting  is  delayed,  and  a  poisonous  amount  is  more  readily  taken 
up  into  the  circulation.  This  does  not  conflict  with  the  statement  made 
by  Trousseau,  that  if  a  patient  be  living  well,  irritant  effects,  such  as 
vomiting  and  purging,  are  more  likely  to  occur  from  medicinal  doses  of 
antimony,  while  spare  diet  favors  the  production  of  constitutional  effects, 
such  as  sedation  and  increased  secretion,  without  so  much  gastric  irrita- 
tion. This  fact  has  been  explained  by  the  presence  of  more  chlorides  in 
a  full  diet  (as  compared  with  a  spare  one),  leading  to  the  formation  of 
more  of  the  irritant  chloride  of  antimony  (Mialhe);  but  Bellini  found 
that  no  such  decomposition  occurred  with  artificial  gastric  juice  at  the 
temperature  of  the  body,  and  the  hypothesis  of  Mialhe  has  not  been  ac- 
cepted. 

If  the  mucous  membrane  of  the  alimentary  tract  be  inflamed,  the  irri- 
tant effects  of  antimony  are  proportionately  severe. 

Absorption  may  occur  through  the  skin,  though  not  readily  while  the 
epidermis  is  intact.  After  frictions  with  antimonial  ointment  vomiting 
has  occurred,  and  the  drug  has  been  found  in  the  urine  (Coze:  Bulletin 
de  Therapeutique,  1869). 

Antimony  is  eliminated  by  the  kidneys,  the  skin,  by  the  mucous 
membrane  of  the  bronchi,  and  (mainly)  by  that  of  the  intestines,  and  by 
the  intestinal  glands.  Orfila  recorded  its  special  determination  to  the 
lungs,  and  Millon  to  the  liver  (Annales  d1  Hygiene^  vol.  xxxri.).  An  im- 
portant fact  is  that  elimination  occurs  by  the  intestinal  tract,  even  when 
the  drug  has  been  given  by  the  veins,  the  rectum,  or  any  other  channel 
(Hermann,  Richardson,  Brinton,  and  others,  Lancet,  i.,  1856).  The 
amount  passed  out  by  the  kidneys,  and  probably  by  the  other  glands, 
varies  at  different  times  in  the  same  individual,  for  Mayerhofer,  while 
continuing  to  take  the  drug,  found  it  only  occasionally  present  in  the 
urine  (Heller's  Archives,  1846). 


ANTIMONY.  279 

The  time  of  its  remaining  in  the  system  has  been  variously  estimated. 
According  to  Taylor,  it  passes  wholly  from  the  stomach  within  a  short 
time,  and  may  then  be  found  in  the  liver,  the  kidneys,  and  spleen,  and  in 
smaller  quantities  in  the  blood.  After  a  few  weeks,  all  traces  have  dis- 
appeared from  these  tissues,  but  some  may  be  found  in  the  fat  and  the 
bones;  generally,  elimination  is  complete  in  from  twenty  to  twenty-five 
days,  but  according  to  Millon  and  Layran,  the  drug  may  be  found  in  the 
liver  and  intestines  four  months  after  administration  (loc.  cit.). 

PHYSIOLOGICAL  ACTION  (EXTERNAL). — The  watery  solution  of  tartar 
emetic  applied  to  the  skin  acts  as  a  elight  irritant,  producing  redness,  but 
the  ointment  when  rubbed  in  acts  more  powerfully,  causing  inflammation 
and  pustulation;  caries  of  subjacent  bone  has  even  been  traced  to  it.  The 
pustules  produced  by  antimony  are  very  painful;  they  are  irregular  in 
size  and  shape,  but  being  often  umbilicated,  resemble  those  of  variola: 
they  mature  about  the  fifth  day,  forming  scabs;  sometimes  they  slough 
and  leave  scars.  Individuals  vary  much  in  susceptibility  to  the  ointment, 
and  during  fever,  or  severe  visceral  inflammation,  pustulation  is  not  easily 
induced. 

It  has  been  stated  that  alkalies  mixed  with  antimonial  salves  prevent 
their  pustulating  effect,  and  also,  but  incorrectly,  that  freshly-blistered 
surfaces  do  not  pustulate  because  of  the  alkalinity  of  the  serum:  on  the 
other  hand,  acids  increase  the  effect  (M.  Coze,  loc.  cit.). 

If  concentrated  solutions  be  taken  by  the  mouth,  they  are  liable  to 
cause  inflammation  and  even  aphthous  ulceration  about  the  gums,  fauces, 
and  oesophagus,  so  that  an  "  antimony  sore  throat "  has  been  described, 
and  its  accompanying  salivation  and  dysphagia  may  be  very  severe. 
Conditions  much  resembling  those  of  diphtheria  have  also  occurred  (Med- 
ical Times,  i.,  1846),  but  are  not  often  met  with  under  the  present  more 
cautious  use  of  the  drug. 

The  prolonged  contact  of  antimony  determines  in  the  intestinal  mucous 
membrane  local  phlegmasise  analogous  to  those  already  described  as  oc- 
curring in  the  skin;  Trousseau  verified.this  by  post-mortem  examinations. 

PHYSIOLOGICAL  ACTION  (INTERNAL). — Circulatory  System. — Under 
the  influence  of  antimony,  the  blood  is  altered  in  its  chemical  characters 
(Richardson),  but  in  a  manner  not  yet  well  understood;  it  may  certainly 
become  impoverished  from  destruction  of  red,  and  increase  of  white  cor- 
puscles (Schmidt),  just  as  under  the  action  of  arsenic  (Koschlakoff) :  in 
cases  of  poisoning  by  the  drug,  it  has  been  found  more  fluid  and  less 
coagulable  than  normal,  the  amount  of  fibrine  being  diminished. 

A  prominent  symptom  of  the  full  action  of  antimony  is  depression  of 
the  circulation,  both  as  to  force  and  rapidity;  but  such  depression  is  often 
preceded  by  a  rise  in  the  pulse-rate,  and  a  similar  rise  may  occur  before 
death  in  the  later  stages  of  poisoning. 

Ackermann,  indeed,  experimenting  upon  healthy  men  with  emetic 


280  MATERIA    MEDICA    AND    THERAPEUTICS. 

doses  (about  f  gr.  of  the  tartrate),  found  a  prolonged  rise  in  the  pulse- 
rate,  to  an  average  maximum  extent  of  42  per  minute,  and  this  was  dis- 
tinctly related  to  the  gastric  symptoms.  The  rise  began  only  with  the 
onset  of  nausea,  and  increased  with  the  occurrence  of  vomiting,  after 
which  the  pulse  fell  to  an  ordinary  level:  it  became  also  soft  and  weak  in 
proportion  to  its  quickness,  but  he  did  not  observe  any  decided  fall  below 
the  normal  rate  at  any  period  (Abstract,  British  and  Foreign  Review, 
April,  1859). 

These  observations  were  carefully  made,  the  pulse  being  examined 
every  five  minutes  ^or  several  hours,  but  they  illustrate  only  the  effect  of 
one  or  two  doses.  There  can  be  little  doubt  that  a  longer  course  of  the 
same,  or  a  larger  initial  dose,  would  have  induced  the  slowing  of  pulse 
which  has  been  verified  by  so  many  observers;  but  we  may  note  a  parallel 
observation  made  by  Trousseau,  that  in  some  few  persons  taking  antimony 
the  pulse  became  and  continued  quick,  as  well  as  weak  and  irregular. 
Usually,  as  at  first  stated,  slowing  of  the  pulse  is  a  marked  and  somewhat 
persistent  effect  of  antimony,  and  especially  so  when  vomiting  does  not 
occur  at  all,  or  after  it  has  ceased:  from  six  to  ten  beats  per  minute  is  an 
average  amount  of  decrease  after  doses  of  1  to  2  gr.,  but  it  may  vary 
from  three  beats  to  forty  (Pecholier,  Bonamy).  Gubler  has  noted  a  pro- 
portion between  the  ultimate  fall  and  the  primary  increase.  (Whether 
such  primary  increase,  when  it  occurs,  is  due  to  a  temporary  excitation  of 
the  whole  system,  or  to  paralysis  of  the  regulating  branches  of  the  vagus, 
has  been  a  question:  the  former  is,  I  think,  more  probable).  Arterial 
pressure  is  much  diminished,  and  the  curves  of  a  sphygmogram  may  be 
almost  effaced  (Bordier):  more  or  less  venous  congestion  also  occurs. 

After  very  large  doses,  any  acceleration  is  but  slight  and  transient,  be- 
fore the  blood-current  becomes  slow  and  almost  imperceptible.  In  frogs, 
dogs,  or  rabbits,  when  a  sufficient  dose  has  been  introduced  by  any  channel, 
the  cardiac  contractions  also  soon  become  slower,  weaker,  and  irregular,  the 
auricles  contracting  oftener  than  the  ventricles.  When  death  occurs  from 
the  drug  it  is  said  to  be  always  through  cardiac  palsy  (Richardson),  the 
general  state  of  collapse  being  secondary  to  failure  of  the  circulation. 
Arrest  finally  occurs  in  diastole,  and  the  irritability  of  the  cardiac  muscle 
is  found  to  be  impaired  or  lost  (Radziejewski,  Bellini),  probably  owing 
to  a  directly  paralyzing  influence  on  the  cardiac  muscular  structure  when 
reached  by  the  drug  after  absorption.  When  antimony  is  applied  to  the 
batrachian  heart,  removed  from  the  body,  similar  slowing  and  arrest  take 
place,  which  is  another  reason  for  considering  the  action  to  be  directly  on 
the  muscular  structure.  It  is  curious  that  in  animals  subjected  to  toxic 
doses,  death  can  be  delayed  for  some  hours  by  dividing  the  vagi  (Majen- 
die).  \ 

Rabuteau  notes  the  remarkable  analogy  between  the  above  action  of 
antimony,  and  that  of  digitalis.  Nobiling  traced  the  depressant  effects 


ANTIMONY.  281 

described  to  the  potash,  rather  than  to  the  antimony  in  tartar  emetic,  but 
bis  observations  have  been  disproved. 

Respiratory  System. — In  the  experiments  of  Ackermann,  the  number 
of  respirations  increased  in  direct  relation  with  the  increase  in  the  pulse- 
rate,  but,  under  the  continued  influence  of  the  drug,  independently  of  irri- 
tant effects,  and  of  any  preventing  lung-disorder,  the  rate  of  respiration 
is  slowed.  It  may  be  so  by  as  much  as  half  or  two-thirds  the  normal  rate, 
so  that  only  six  respirations  occur  per  minute,  and  this  without  general 
distress  or  impairment  of  other  functions  (Trousseau). 

After  poisonous  doses,  the  breathing  is  very  irregular,  at  one  time 
hurried,  short,  and  painful,  at  another,  extremely  slow,  with  labored  and 
forcible  inspiration  and  expiration:  this  is  due  in  part  to  paralysis  of  the 
heart  and  other  muscles,  in  part  to  impairment  of  reflex  sensibility  and  to 
altered  conditions  of  the  blood.  After  death  in  such  cases,  Majendie,  find- 
ing the  lungs  partially  congested  and  hepatized,  concluded  that  the  action 
of  antimony  was  specially  exerted  on  these  organs,  and  Mayerhofer 
certainly  proved  its  elimination  by  their  mucous  membrane:  ecchymo- 
ses  and  emphysema  are  found  when  the  act  of  breathing  has  been  very 
labored. 

The  effect  of  the  drug  upon  the  excretion  of  carbonic  acid  has  been 
differently  stated:  some  observers  report  it  lessened  in  amount  (Coze, 
Mialhe,  Rabuteau),  but  recent  writers  (Ringer,  Bartholow),  express  an  ex- 
actly opposite  opinion,  though  neither  gives  his  original  authority  (u.  p. 
283).  Further  accurate  observations  upon  this  point  are  admittedly  want- 
ing, but  having  regard  to  the  sedative  effects  of  sufficient  doses,  inde- 
pendently of  inflammatory  action,  the  former  statement  seems  to  me  more 
in  accordance  with  known  facts.  That  arsenic  lessens  the  excretion  of 
carbonic  acid  is  now  recognized,  and  though  Gubler  holds  that  we  do  not 
know  enough  of  arsenical  action  to  make  the  analogy  of  scientific  value, 
I  should  hesitate  before  ascribing  to  so  closely  an  allied  drug  as  antimony, 
a  directly  opposite  effect  in  this  important  particular. 

Digestive  System. — Upon  the  alimentary  tract,  antimony  acts  as  an 
irritant  in  greater  or  less  degree,  according  to  the  dose:  -fa  to  -^  gr.  of 
the  tartrate,  or  even  less  when  repeated,  will  induce  some  sense  of  warmth 
in  the  stomach,  and  some  increase  of  its  secretions;  £  to  £  gr.  will  cause, 
in  addition,  a  feeling  of  soreness,  a  flow  of  saliva,  impairment  of  appetite, 
and  possibly  nausea;  £  to  1  gr.,  given  in  a  glass  of  water,  will  usually  in- 
duce vomiting  within  fifteen  to  thirty  minutes.  The  vomiting  is  distres- 
sing in  character,  accompanied  with  shivering,  much  depression,  retching1, 
and  persistent  nausea:  the  ejecta  contain  mucus,  and  later,  bile.  Tho 
same  dose  generally  purges,  and  if  taken  with  a  large  quantity  of  water 
will  be  almost  sure  to  do  so,  either  with  or  without  vomiting.  The  evac- 
uations at  first  are  simply  fluid,  then  mixed  with  free  bile,  and  are  passed 
with  some  straining  and  griping  pain.  It  is  noteworthy  that  a  larger 


282  MATEEIA    MEDICA    AKD    THERAPEUTICS. 

dose  is  required  to  produce  these  effects  when  given  by  intravenous  in- 
jection than  by  the  stomach. 

Large  doses  of  10  to  20  gr.  or  more,  act  very  severely;  the  local  irrita- 
tion and  burning  pain  are  great;  vomiting  occurs  quickly  and  with  much 
distress;  there  is  difficulty  in  swallowing,  spasm  of  oesophagus,  severe 
tenesmus  and  cramp  in  the  abdominal  muscles,  and  profuse  diarrhoea  of 
sero-albuminous  fluid,  containing  flocculi  of  detached  epithelium  (like  the 
rice-water  stools  of  cholera),  and  sometimes  blood. 

In  fatal  cases  the  mucous  membrane  of  the  stomach  and  of  parts  of 
the  intestine,  especially  the  lower  portions  and  the  rectum,  has  been  found 
acutely  congested  or  inflamed,  softened,  aphthous,  or  ulcerated. 

Conditions  modifying  the  Action  of  Antimony — Tolerance,  etc. — 
The  preceding  description  requires  to  be  qualified,  especially  in  cases  of 
what  is  called  "tolerance."  If  the  giving  of  antimony  be  commenced 
in  fractional  doses,  and  continued  with  very  gradual  increase,  it  is  possi- 
ble to  produce  full  sedative  effects  without  gastric  disturbance.  Again, 
in  certain  forms  of  illness,  with  altered  haematosis,  such  as  pneumonia,  or 
in  some  nerve-disorders,  as  chorea  or  delirium  tremens,  full  doses  may  be 
given  without  any  evidence  of  irritation,  and  then  "  tolerance "  of  the 
drug  is  said  to  be  established.  Further,  in  some  instances,  £-dr.  and  1-dr. 
doses  have  been  taken  without  vomiting  (Hicks:  Lancet,  ii.,  1876,  p.  38), 
and  in  other  cases  of  poisoning  from  very  large  doses,  the  prominent  symp- 
toms have  been  those  of  collapse,  and  the  patient  has  died  without  vomit- 
ing or  purging,  or  complaint  of  pain.  Indeed,  not  the  least  of  the  difficul- 
ties in  studying  the  action  of  antimony,  we  find  in  the  circumstance  that 
sometimes  there  is  no  post-mortem  evidence  of  irritation  or  inflammation 
to  be  found,  either  in  stomach  or  intestine  (Handfield  Jones,  Bellini,  Bock- 
er).  As  with  other  powerful  drugs,  there  may  also  exist  some  idiosyn- 
crasy in  certain  persons,  leading  to  difference  in  result  that  we  cannot 
otherwise  explain,  but  the  account  I  have  given  represents  the  effects  as 
usually  observed:  as  a  rule,  it  acts  with  most  intensity  on  the  delicate, 
on  women,  and  more  especially  on  children,  and  in  these  subjects  "  toler- 
ance "  is  less  easily  induced  than  in  men,  and  lasts  for  a  shorter  time. 
When  tolerance  has  once  ceased,  great  care  must  be  exercised  in  resum- 
ing the  drug,  for  it  will  more  readily  excite  gastric  derangement  (Trous- 
seau). 

Glandular  System. — Moderate  doses  increase  the  secretion  of  the 
parotid,  the  pancreas,  the  liver,  and  the  gastric  and  intestinal  glands,  the 
drug  acting  as  a  stimulant  or  irritant  during  its  elimination  by  these 
structures. 

The  increased  secretion  has  been  variously  attributed  to  irritation  of 
the  gland-cells,  and  to  paralysis  of  their  controlling  nerves:  the  former  is 
the  primary,  the  latter  a  secondary  effect. 

Cutaneous  System. — Whether  it  has  a  like  action  on  the  sweat-glands 


ANTIMONY.  283 

has  been  disputed,  and  the  increased  perspiration  which  commonly  follows 
its  use  has  been  attributed  to  the  act  of  vomiting  or  to  the  course  of  an 

O  * 

illness  (Trousseau).  It  is  true  that  when  the  remedy  is  "  tolerated  "  there 
is  usually  little  sweating,  but  this  need  imply  only  that  under  certain 
conditions  less  of  the  drug  is  excreted  by  the  skin.  In  my  own  experi- 
ence, diaphoresis  has  occurred  clearly  from  antimonial  action,  independ- 
ently of  vomiting,  and  this  seems  quite  in  accord  with  the  increased 
secretion  from  other  glands.  (I  do  not  here  refer  to  the  profuse  cold 
sweating  of  later  stages  of  poisoning, — the  result  of  exhaustion.) 

Neither  do  I  see  any  difficulty  in  accepting  the  (few)  recorded  cases 
of  pustular  eruption  following  the  internal  use  of  antimony  (Gleaves, 
Booker,  Mayerhofer,  Taylor).  The  drug  is  certainly  eliminated  in  greater 
or  less  extent  by  the  skin,  and  that  it  may  sometimes  cause  suppuration 
is  not  more  unlikely  than  in  the  case  of  iodide  of  potassium. 

Urinary  System. — There  is  difficulty  in  estimating  exactly  the  effect 
of  antimony  on  the  kidneys,  and  statements  with  regard  to  it  vary 
much.  It  is  probable  that  more  or  less  of  the  drug  may  be  excreted  by 
this  channel,  according  to  circumstances,  for,  as  already  stated,  Mayer- 
hofer, experimenting  on  himself,  could,  at  one  time,  detect  it  in  his  urine, 
and  at  another  time,  not;  he  found  the  amount  of  urine  at  first  increased, 
afterward  lessened.  Trousseau  and  Gubler  report  a  marked  increase  in 
the  secretion  only  when  vomiting  and  purging  were  absent  or  slight,  and 
this  was  the  case  also  in  Hannon's  experiments. 

If  the  circulation  be  extremely  depressed,  or  if  choleraic  symptoms 
occur,  the  urine  is  likely  to  become  scanty,  or  even  suppressed. 

Other  observers  distinguish  between  the  different  constituents  of  the 
urine;  Bocker,  taking  himself  2|-  gr.  daily  for  nine  days,  found  the  urea 
and  other  urinary  solids  markedly  lessened,  and  Beigel,  giving  a  similar 
dose  to  four  patients  for  four  days,  obtained  the  same  results:  in  both  in- 
stances, comparatively  little  food  was  taken. 

Dr.  Parkes,  however,  found  the  amount  of  urea  increased  after  sul- 
phuret  of  antimony,  and  several  modern  writers  (Ringer,  Bartholow)  de- 
scribe a  similar  increase,  relying,  probably,  on  the  observations  of  Acker- 
mann.  His  subjects  received  a  cup  of  coffee,  and  then  remained  in  bed 
for  a  day,  taking  from  1  to  2  gr.  of  tartar  emetic,  which  caused  emesis 
and  often  purgation.  He  reported  that  the  water  and  the  chlorides  were 
diminished  in  proportion  to  the  diarrhosa,  but  urea  was  increased  by  one- 
eighth,  or  even  one-fourth,  and  uric  acid  and  pigment  were  also  increased: 
these  results  he  attributed  to  increased  metamorphosis.  I  cannot,  how- 
ever, accept  them  as  conclusive  evidence  of  the  full  action  of  antimony, 
for  the  lowering  of  circulation  and  of  temperature,  and  relaxation  of  ves- 
sels, and  the  analogy  of  allied  medicines  (arsenic,  digitalis)  suggest  so 
forcibly  an  opposite  conclusion  (v.  p.  281).  Further  experiments  are 
required  on  this  point:  meanwhile,  I  cannot  but  agree  with  Rabuteau  and 


284  MATERIA    MEDICA    AND    THERAPEUTICS. 

others  in  classing  the  drug  with  those  which  moderate  or  diminish  the 
nutritive  processes,  and  which  therefore  tend  to  lessen  the  excretion  of 
urea  as  well  as  of  carbonic  acid.  As  a  curious  illustration  of  the  power 
of  antimony  to  lessen  excretion  and  lower  true  nutrition,  we  may  refer  to 
a  custom  common  in  Germany  of  using  "  glass  of  antimony  "  in  the  food 
to  fatten  fowls  and  animals. 

Temperature. — There  is  a  similar  discrepancy  in  observations  on  tem- 
perature,— a  discrepancy  which  must  depend  upon  difference  in  dosage, 
or  in  continuance  of  the  medication,  or  in  the  reaction  of  healthy  as 
against  weakly  subjects.  Thus,  Ackermann  found  the  .hands  and  face 
become  cold  during  the  period  of  nausea,  but  after  vomiting  they  be- 
came warmer,  and  the  mouth-temperature  did  not  fall,  but  increased 
about  1°  F. 

Dr.  Ringer  made  a  very  complete  experiment  when  he  gave  \  gr.  of 
tartar  emetic  every  ten  minutes  for  seven  hours,  inducing  vomiting  and 
sweating,  and  yet  the  temperature  did  not  vary  more  than  0.4°  F.  On 
the  other  hand,  Pecholier  observed  the  temperature  to  fall  in  direct  ratio 
with  the  pulse,  and  the  amount  of  fall  has  been  stated  at  from  1°  to  3°  C. 
(Hirtz,  Gubler):  a  brief  and  slight  preceding  rise  has  been  noted  by  the 
latter  physician. 

In  cases  of.  poisoning  the  depression  of  temperature  is  very  marked, 
and  in  another  series  of  experiments  made  by  Ackermann  on  animals,  it 
amounted  to  nearly  7°  C.  in  those  that  survived  a,  few  hours. 

Nervous  and  Muscular  Systems. — These  systems  are  first  excited  and 
then  paralyzed  by  antimony  in  varying  degree  according  to  the  dose  and 
the  amount  of  gastric  irritation.  Restlessness  and  pain  may  be  at  first 
marked  with  general  tremor  and  spasmodic  contraction  of  the  muscles, 
either  of  the  abdomen,  the  jaw,  the  oesophagus,  or  extremities,  especially 
of  the  hands  (case  of  Mrs.  Prichard,  etc. — cases  by  Orfila,  Elliotson,  etc.). 

In  animals,  reflex  sensibility  is  much  diminished  (Radziejewski),  and 
some  degree  of  motor  palsy  occurs:  these  effects,  so  far  as  they  are  cen- 
tral in  origin,  are  spinal  rather  than  cerebral,  for  they  occur  equally  when 
the  cerebral  centre  is  separated. 

They  have  not  been  so  marked  in  man,  but  great  muscular  prostration 
is  quickly  induced,  and  profound  collapse  is  a  characteristic  symptom  of 
antimonial  poisoning:  in  some  exceptional  cases  it  has  been  more  marked 
than  any  irritant  symptoms. 

There  may  be  temporary  loss  of  consciousness  and  semi-narcotism 
(case  of  Mr.  Bravo),  or  convulsion,  and  later  delirium  (Orfila),  but  usually 
the  mind  remains  or  becomes  clear  before  death. 

Fatal  Dose. — The  minimum  fatal  dose  for  an  adult  may  be  stated  at  2 
gr. ;  for  a  child,  f  gr. 

The  post-mortem  appearances  have  been  sufficiently  indicated.  We 
need  only  note  further  confirmatory  evidence  of  the  power  of  antimony 


ANTIMONY.  285 

to  produce  fatty  degeneration  in  the  experiments  of  Salkowski,  who 
found  this  change  in  the  viscera  of  animals  after  adding  8  to  15  gr.  per 
diem  of  an  antimonial  compound  to  their  ordinary  food. 

Theory  of  Action. — There  has  been  much  discussion  as  to  whether 
the  vomiting  and  purging  which  are  produced  by  antimony  are  due  to 
direct  gastro-intestinal  irritation,  or  are  secondary  to  an  influence  exerted 
on  the  nerve-centres  (medulla  oblongata)  by  the  drug  after  absorption. 
The  former  view  was  commonly  accepted  until  Majendie's  experiment  of 
substituting  in  an  animal  a  bladder  for  the  natural  stomach,  and  then 
causing  vomiting  by  intravenous  injection  of  antimony.  Such  an  experi- 
ment seemed  to  prove  that  emesis  was  effected  through  the  nerve-centres 
independently  of  the  stomach;  and  besides  this,  the  persistence  of  the 
nausea  seemed  to  indicate  more  than  an  ordinary  (mechanical)  irritation. 
Chouppe  has  also  concluded  from  recent  experiments  that  although  an- 
timony may  act  by  such  irritation,  it  more  usually  acts  after  absorption. 
He  divided  the  vagus  nerve  in  dogs;  and  after  subsidence  of  the  retching 
from  the  operation,  injected  antimony  into  the  cellular  tissue  or  veins, 
and  vomiting  followed  as  usual:  as  an  experiment  for  contrast,  he  in- 
jected in  other  dogs  emetine,  and  when  the  vagi  were  divided  this  caused 
no  vomiting  (Abstract,  Lancet,  ii.,  1874,  p.  532).  Broussais  and  others,  how- 
ever, always  maintained  the  earlier  views  as  to  local  irritation,  and  they 
are  further  supported  by  the  following  evidence: — (1)  Emesis  has  oc- 
curred before  any  antimony  could  be  detected  in  the  blood  (Mayerhofer). 
(2)  In  several  instances  nearly  the  whole  of  a  dose  of  antimony  has  been 
recovered  from  the  vomited  matters — implying  that  very  little,  if  any, 
absorption  could  have  occurred  before  vomiting  (Radziejewski).  (3)  In 
almost  all  fatal  cases,  marked  congestion  or  signs  of  irritation  have  been 
found  in  the  stomach  after  death,  and  this  even  when  the  drug  has  been 
given  by  the  veins  or  other  channels.  It  has  clearly  been  proved  that  elim- 
ination occurs  from  the  gastric  membrane  under  such  circumstances, 
and  it  is  probable  that,  in  Majendie's  experiment,  the  drug  was  eliminated 
by  the  pharynx  and  by  the  intestine,  and  produced  vomiting  just  as  if 
introduced  into  the  natural  stomach  (Hermann,  Grimm,  Brinton,  Richard- 
son). (4)  A  smaller  dose  will  produce  vomiting  when  given  by  the  mouth 
than  when  given  by  the  veins;  this  seems  a  crucial  experiment  on  the 
point,  and,  although  an  opposite  statement  has  been  made  by  some  ob- 
servers, it  has  been  verified  by  Hermann,  Grimm,  Kleimann,  etc.,  and  it 
is  agreed,  of  course,  that  general  symptoms  occur  also  after,  and  in  conse- 
quence of,  absorption,  and  that  nausea  and  prostration  are  prolonged  in 
consequence  of  such  absorption. 

Another  question  is,  whether  the  deeply  depressing  effects  of  the  drug 
are  due  to  a  special  "  contra-stimulant "  action  (Rasori),  or  whether  they 
are  only  secondary  to  the  emetocatharsis  (Broussais).  I  must  conclude 


286  MATERIA   MEDICA   AND    THERAPEUTICS. 

also  on  this  point,  that  without  denying  a  depressant  effect  after  absorp- 
tion, and  poisoning  of  the  nerve-centres,  the  muscular  tissue,  etc.,  yet  the 
early  depression  and  collapse  depend  rather  on  the  gastric  irritation,  the 
nausea,  and  the  vomiting,  and  are  due  to  reflex  action  on  the  sympathetic 
and  pneumogastric  centres.  We  know  that  nausea  from  any  cause  is  ac- 
companied with  prostration,  faintness,  chilliness,  and  pallor,  and  antimo- 
nial  nausea  causes  the  same  symptoms  in  a  similar  manner,  without  invok- 
ing any  speciality  in  its  action  (Gubler). 

Tolerance,  we  may  explain  in  some  instances,  perhaps,  by  the  fact  of 
only  partial  absorption  occurring,  e.g.,  through  deficiency  in  the  gastric 
secretions  during  fever;  but  this  will  not  explain  it  so  completely  as  some 
have  supposed,  because  the  induced  feebleness  of  circulation  and  respira- 
tion, and  occasional  occurrence  of  organic  lesions,  prove  that  sufficient  ab- 
sorption must  have  taken  place  to  cause  the  ordinary  effects. 

A  more  reasonable  explanation  is  to  be  found  in  the  impaired  nerve- 
condition,  and  especially  the  diminution  of  reflex  excitability  in  the  sub- 
jects of  "tolerance." 

We  may  say  that  all  those  in  whom  it  is  evident  at  once  (so  that  they 
bear  "  Rasorian "  doses  of  one  or  more  drachms  without  any  pain  or 
vomiting),  are  either  suffering  from  some  neurosis  of  stomach  or  vagus, 
or  from  some  grave  malady,  as  pneumonia,  which  clearly  lowers  their 
vital  power:  and  in  those  persons  in  whom  tolerance  has  been  slowly  in- 
duced by  the  gradual  increase  of  small  doses,  we  may  presume  that  anti- 
mony has  exerted  its  known  power  of  diminishing  reflex  activity,  and 
has  thus  reduced  the  patients  in  this  respect  to  the  condition  of  invalids, 
even  if  in  other  respects  convalescent. 

Moreover,  in  many  cases  of  tolerance,  though  there  has  been  no 
vomiting,  yet  diarrhoaa  has  occurred,  and  the  absence  of  vomiting,  which 
is  a  complex  act,  may  simply  mean  that  reflex  nerve-power  is  too  much 
impaired  for  its  production,  diarrhosa  being  a  simpler  process. 

In  women  and  children,  reflex  nerve-activity  is  higher  than  in  the 
average  man,  which  fact  would,  according  to  the  previous  hypothesis, 
explain  why  tolerance  is  less  readily  induced  in  them. 

SYNERGISTS. — Other  emetics,  such  as  ipecacuanha,  and  other  purga- 
tives, such  as  calomel,  increase  the  effects  of  antimony.  Sedatives,  such 
as  bleeding,  and  more  especially  digitalis  and  veratrum,  have  an  allied 
action:  also  other  medicines  which  under  certain  circumstances  quiet 
febrile  excitement,  as  quinine  in  full  doses,  arsenic,  bromides,  citric  and 
tartaric  acids. 

ANTAGONISTS  AND  INCOMPATIBLES. — Aromatic,  alcoholic,  and  other 
diffusible  stimulants  counteract  the  depressant  effects  of  antimony.  Nar- 
cotics, and  especially  opium,  hinder  its  special  action  (Rasori) — Gubler, 
indeed,  calculates  that  opium  lessens  its  power  by  one-half,  and  considers 
it  much  better  to  give  a  half-dose  in  any  case,  or  to  give  the  narcotic 


ANTIMONY.  287 

separately,  than  to  combine  such  antagonists.  Graves,  however,  has 
proved  a  clinical  value  in  the  combination,  and  Laennec  found  antimony 
better  borne  when  conjoined  with  opium  and  aromatics. 

Cold  acts  as  a  partial  preventer  of  vomiting,  and  warmth,  of  diar- 
rhoea. 

Mechanical  antidotes  are  such  as  oil,  thickened  milk,  and  mucilagi- 
nous substances:  and  tannin,  in  all  its  forms,  is  a  powerful  chemical  anti- 
dote: decoctions  of  oak  and  cinchona  bark,  gall-nuts,  strong  tea,  etc., 
may  be  used,  and  life  has  been  saved  by  these  agents  in  apparently 
hopeless  cases  of  poisoning. 

THERAPEUTICAL  ACTION  (EXTERNAL). — The  ointment  acts  as  a  strong 
local  irritant,  and  was  much  employed  when  counter-irritation  was  more 
highly  esteemed  than  it  is  at  present.  The  pustulation  caused  by  anti- 
mony is  more  painful,  but  perhaps  more  permanent  in  its  good  results, 
than  that  produced  by  croton  oil. 

Phthisis. — In  the  earlier  stages  of  this  disease,  when  there  is  evidence 
of  local  lung-congestion,  with  pain  and  oppression,  and  in  the  later 
stages  when  acute  general  symptoms  are  not  urgent,  I  have  known  it 
serviceable.  Dr.  Hogg  recommended  its  application  on  plaster,  sprink- 
ling about  4  gr.  of  finely  powdered  tartar  emetic  upon  the  surface  of  an 
ordinary  warm  "  pitch-plaster: "  in  the  course  of  a  few  days  this  pro- 
duced much  irritation  and  a  crop  of  pustules.  It  seems  rather  severe 
treatment,  but  is  sometimes  beneficial  (British  and  Foreign  Revieict 
ii.,  1860,  p.  382). 

Meningitis — Hydrocephalus. — In  these  maladies,  the  ointment  has 
been  applied  over  the  shaven  scalp,  but  the  results  certainly  do  not  com- 
pensate for  the  suffering  caused. 

Orchitis — Ovaritis. — Frictions  with  the  ointment  have  been  made  in 
orchitis,  along  the  line  of  the  spermatic  cord  as  far  as  the  scrotum,  the 
skin  having  been  previously  punctured.  M.  Isaac  reports  well  of  this 
procedure  (Practitioner,  1869),  but  I  cannot  think  it  desirable;  it  has 
proved  unsuccessful  under  my  own  observation.  Dr.  Rigby  speaks  very 
highly  of  the  good  effect  of  counter-irritation  by  antimonial  ointment 
in  ovaritis  ("  Diseases  of  Women  "). 

Ncevus. — Mr.  Bateman  recommends  a  resin  plaster  made  -with  two 
parts  to  one  of  tartar  emetic,  and  applied  over  the  naevus  until  inflam- 
matory action  and  pustulation  occur  (Lancet,  ii.,  1869).  I  have  several 
times  pursued  with  success  a  similar  plan. 

Lupus — Cancer. — The  chloride  of  antimony  has  been  employed  as  a 
destructive  caustic  for  these  growths,  but  is  now  practically  superseded. 

THERAPEUTICAL  ACTION  (INTERNAL). — The  double  power  of  antimony 
to  control  circulation  and  nerve-excitement,  at  the  same  time  that  it  in- 
creases secretion,  indicates  its  use  in  many  diseases,  and  especially  in 
those  of  febrile  and  inflammatory  character;  on  the  other  hand,  the  ex- 


288  MATERIA    MEDICA    AND    TIIEKAPEUTICS. 

treme  depression  that  may  be  caused  by  it  has  led  to  serious  results  in 
incautious  hands;  hence  much  controversy  as  to  the  true  value  of  the 
drug,  and,  while  by  some  writers  it  has  been  extolled  as  the  best  of  reme- 
dies, it  has  been  described  by  others  as  too  dangerous  a  poison  to  be 
used. 

Forbidden  in  France  by  special  law  in  the  sixteenth  century,  it  was, 
not  long  afterward,  received  into  the  Codex,  and  about  the  same  time  our 
"  Earl  of  Warwick's  powder,"  consisting  of  the  sulphuret  of  antimony, 
with  cream  of  tartar  and  scammony,  obtained  a  wide  reputation.  The 
tartrate  of  antimony  and  potash  was  introduced  somewhat  later  (by 
Mynsicht),  and  has  continued  in  general  estimation  and  daily  use  down 
to  our  own  time. 

Within  the  last  twenty  years,  however,  and  since  the  value  of  tonic 
and  restorative  treatment  has  been  better  recognized,  antimony  has,  like 
bleeding  and  other  depressants,  been  more  rarely  prescribed,  and  at  pres- 
ent it  may  be  questioned  whether  its  great  therapeutical  powers  are 
sufficiently  appreciated.  We  do  not  hold  that  this,  more  than  other 
medicines,  has  a  separate  or  specific  action  for  each  of  the  various  dis- 
eases we  are  about  to  mention, — that  it  cures  convulsion  in  general,  or 
pneumonia,  or  rheumatism  as  separate  nosological  species  (Gubler),  but 
rather  that  it  exerts  an  exceptionally  marked  influence  on  certain  patho- 
logical states,  which  either  cause  or  complicate  these  and  many  other 
maladies. 

Fevers. — At  the  commencement  of  an  attack,  when  gastric  disorder 
was  very  marked,  an  antimonial  emetic  was  formerly  much  commended. 
Dr.  Gregory  often  employed  it  in  these  circumstances,  but  he  also  pointed 
out  the  danger  of  inducing  irritability  of  the  stomach,  and  even  inflam- 
mation. Dr.  Graves  and  others  have  taught  that  such  an  emetic,  given 
within  thirty-six  hours  of  the  initial  rigor,  would  often  abort  the  fever, 
but  this  is  difficult  to  prove,  and  is  not  generally  accepted.  Modern 
practice  has  rather  taught  us  that  nausea  and  vomiting  are  usually  need- 
less annoyances  to  the  patient,  though  if  induced  in  the  early  stages 
vomiting  may  certainly  relieve  headache  and  severe  gastric  congestion 
when  dependent  upon  accumulated  mucus  and  bile. 

Dr.  Graves  originated,  and  highly  praised  also,  the  administration  of 
antimony  in  fever  (especially  typhus)  at  a  stage  when  cerebral  complica- 
tions are  sometimes  very  severe,  e.g.,  from  the  seventh  to  the  ninth  day. 
Thus,  to  a  strong  adult,  suffering  with  complete  insomnia,  illusions  of  the 
senses,  delirium,  continued  tremor  and  subsultus,  "cerebral"  respiration, 
very  quick  and  weak  pulse,  sordes,  and  every  symptom  of  the  worst 
augury,  ^  gr.  of  tartar  emetic  in  water  was  given  every  hour:  the  patient 
vomited  freely  (though  not  directly)  after  each  of  the  first  four  doses, 
then  purging  began,  the  general  condition  improved,  and  the  man  slept: 
after  temporary  omission  of  the  medicine,  2  min.  of  "  black  drop  "  (opium) 


ANTIMONY.  289 

were  given  every  two  hours,  and  on  the  following  day  there  was  free 
perspiration,  natural  sleep,  and  a  rational  mind;  ultimately  a  good  re- 
covery followed  ("  Clinical  Lectures  "). 

In  other  equally  severe  cases  the  same  dose  of  antimony  has  been 
given  from  the  first  with  2  or  3  min<  of  laudanum,  and  the  results  have 
been  such  as  to  warrant  much  confidence  in  this  method  of  treatment;  it 
is  necessary,  however,  to  use  it  cautiously,  and  to  bear  in  mind  its  weak- 
ening effect  upon  the  cardiac  muscle,  which  is  already  enfeebled  from  the 
effect  of  the  disease  (Murchison). 

Enteric  Fever. — Antimony  has  been  commended  in  this  fever,  but  the 
intestinal  condition  requires  exceptional  caution  in  its  use;  it  does  not  of 
itself  forbid  the  remedy,  for  diarrho3a  and  pain  have  often  subsided  under 
it  (Trousseau),  and  when  the  lungs  are  implicated  it  may  be  especially 
useful. 

M.  Beriard  records  a  case  of  fever  with  secondary  pneumonia  and  de- 
lirium, rapidly  passing  into  a  hopeless  comatose  condition,  which  was 
relieved  at  once  by  free  vomiting  and  purging  from  a  large  dose  (nearly 
6  gr.)  of  tartar  emetic,  and  ultimately  recovered  (Bulletin  de  Therapeu- 
tique,  1873). 

Intermittent  Fever  (Ague}. — The  paroxysms  may  sometimes  be  pre- 
vented by  an  emetic  dose  of  antimony,  but  this  is  not  a  special  effect  of 
the  drug,  for  it  will  occur  after  the  use  of  other  emetics. 

Scarlet  Fever — Measles — Small-pox. — In  these  disorders,  especially 
when  the  eruption  is  scanty  or  suppressed,  antimony  may  be  useful  by 
determining  to  the  skin,  and  thus  relieving  the  febrile  condition  and  ob- 
viating grave  symptoms. 

I  have  given  tartar  emetic  in  small -pox  in  varied  doses,  but  have  never 
known  it  exert  a  modifying  influence  on  the  disease  itself.  In  certain 
complications,  however,  such  as  pneumonia,  bronchitis,  or  acute  delirium, 
doses  of  -fa  to  £  gr.  every  two  or  three  hours,  have  given  relief. 

Antimony  is  exceedingly  useful  in  the  bronchial  catarrh  which  is  often 
a  serious  complication  of  measles:  besides  controlling  the  general  pyrexia, 
it  relieves  the  oppression  of  the  chest,  acts  as  an  expectorant,  and  tends 
to  diminish  a  too  abundant  secretion  of  mucus,  probably  by  lessening 
congestion. 

If  £  gr.  of  tartarated  antimony  be  dissolved  in  4  oz.  of  distilled  water, 
a  teaspoonful  may  be  given  frequently  or  occasionally,  according  to  the 
severity  of  the  cough  or  the  oppression.  In  the  case  of  weakly  children, 
the  amount  of  depression  which  may  be  induced  requires  to  be  carefully 
watched. 

"  Worm  Fever." — In  remittent  pyrexial  conditions  dependent  upon 
intestinal  worms,  I  have  found  small  doses  beneficial,  but  the  emetic  ac- 
tion of  the  drug,  as  a  rule,  is  undesirable. 

Rheumatic  Fever. — Laennec,  Bricheteau,  and  other  eminent  physi- 
VOL.  L— 19 


290  MATERIA    MEDICA    AND    THERAPEUTICS. 

cians  of  a  past  generation,  advocated  the  use  of  large  and  repeated  doses 
in  acute  rheumatism,  but  later  experience  is  against  their  adoption.  I 
formerly  used  £  gr.  doses  with  advantage,  especially  when  the  tempera- 
ture was  not  very  high.  Barbeau  quotes  cases  illustrative  of  its  value  in 
acute  rheumatism,  when  used  as  an  evacuant  previous  to  commencing 
quinine  ( Medico-  Chirurgical  Review,  i.,  1857,  p.  266). 

Lumbago. — In  obstinate  cases  of  ordinary  lumbago  and  local  muscu- 
lar rheumatism,  I  have  ordered  the  same  dose  every  one  or  two  hours  for 
a  short  time  with  excellent  results. 

Erysipelas. — Desault  recommended  the  frequent  use  of  minute  doses 
of  antimony  in  erysipelas,  giving  1  gr.  dissolved  in  a  quart  of  water  in  the 
course  of  twenty-four  hours.  Dr.  A.  J.  Walsh  has  reported  a  number  of 
satisfactory  results  under  this  treatment  (Dublin  Quarterly  Journal, 
August,  1850),  but  I  consider  other  remedies  act  still  better. 

Traumatic  Pyrexia. — In  febrile  conditions  resulting  from  severe  in- 
jury, antimony  has  been  found  useful.  Thus,  Mr.  Denny  found  it  "  act 
like  a  charm  "  in  a  case  of  gun-shot  wound  of  the  chest  with  inflamma- 
tory reaction,  rigors,  delirium,  etc. :  some  nausea  was  induced,  the  pain 
quickly  subsided,  and  in  twelve  hours  the  fever  aborted,  and  sleep  set  in 
(British  Medical  Journal,  i.,  1871).  Speaking,  however,  from  large  ex- 
perience, I  am  satisfied  that  aconite  is  a  more  trustworthy  remedy  in  such 
cases. 

Acute  Inflammations — Orchitis,  Tonsillitis,  etc. — In  minor  local  forms 
of  inflammation,  such  as  of  the  breast  or  testicle,  of  the  tonsil  or  parotid, 
or  of  a  varicose  vein,  the  good  effect  of  small  doses  of  tartar  emetic  is 
often  conspicuous.  Dr.  Beatty  especially  noted  their  power  of  controll- 
ing mammary  inflammation,  as  if  by  "specific  action  on  the  gland." 
After  purgation,  he  gave  ^  gr.  every  hour,  never  desiring  an  emetic  ac- 
tion, but  not  objecting  to  slight  nausea  (Dublin  Journal,  vol.  iv.  ).  Dr. 
Churchill  found  the  same  plan  "more  effective  than  any  other"  (Mid- 
wifery). A  case  of  inflamed  varix  cured  by  this  method  is  related  by 
Dr.  Spender  in  his  essay  on  the  advantages  of  small,  frequent  doses 
(British  and  Foreign  Review,  1872),  and  he  believes  that  the  dose  may 
be  adjusted  with  mathematical  precision  and  certainty :  "  -fa  to  -fa  gr. 
given  every  hour  is  bound  to  control  a  local  phlegmon."  I  have  found  it 
good  in  tonsillitis  and  parotitis,  the  pain,  congestion,  and  pyrexia  being 
often  quickly  relieved,  and  yet  this  is  not  the  treatment  I  usually  adopt, 
nor  do  I  think  it  so  good  as  that  by  aconite  or  belladonna. 

Purulent  and  Strumous  Ophthalmias. — In  these  affections,  tartar  eme- 
tic was  a  usual  remedy  some  years  ago,  and  doubtless  acted  by  abating 
local  congestion;  modern  practice,  however,  places  more  reliance  on  the 
use  of  topical  remedies  and  of  tonics. 

Acute  I&zema. — When  this  malady  occurs  in  persons  of  full  habit — 
especially  if  also  of  gouty  tendencies — and  when  pyrexia,  severe  local 


ANTIMONY.  291 

irritation,  gastric  disorder,  and  loaded  urine  are  present,  I  have  seen 
much  advantage  from  combining  antimony  with  magnesia  or  other  saline 
aperients,  or  with  diuretics.  Meade  also  writes  in  its  favor  (British  Medi- 
calJburnal,  ii.,  1864), 

bronchitis. — Tartar  emetic  seems  to  me  to  exert  almost  a  specific 
effect  on  inflamed  bronchial  membrane.  In  the  case  of  old  people  it  is 
useful  especially  when  the  cough  is  convulsive  in  character,  most  trouble- 
some at  night,  and  attended  with  loud  wheezing  respiration,  paroxys- 
mal dyspnoea,  and  profuse  secretion  of  mucus  which  is,  with  difficulty, 
expectorated.  When  inflammation  affects  the  smaller  tubes  of  young 
adults,  an  emetic  dose  may  be  found  sometimes  desirable,  but  as  a  rule, 
TV  to  i  gr-  every  two  to  three  hours  will  suffice  to  render  free  and  less 
tenacious  the  bronchial  secretion,  to  lower  the  blood-tension,  diminish 
pyrexia,  and  relieve  local  congestion  and  oppression.  The  action  of  the 
skin  and  of  the  kidneys  is  increased  usually  in  inverse  ratio — if  one  is 
more,  the  other  is  less  marked.  If  cough  be  very  severe,  a  little  morphia 
or  belladonna  may  be  combined  with  the  antimony,  while  in  later  stages, 
if  more  stimulus  to  expectoration  is  needed,  squill  is  a  useful  adjunct. 

In  the  capillary  bronchitis  of  children,  tartar  emetic  often  proves 
valuable.  1  have  treated  with  it  nine  cases  during  the  last  season;  all 
were  under  two  and  a  half  years  old,  and  suffered  with  distressing  parox- 
ysmal cough,  which  caused  much  exhaustion;  the  respiration  was  much 
quickened,  the  pulse  130  to  140,  small  and  feeble,  the  temperature  101° 
to  103°  F. ;  there  were  the  ordinary  physical  signs  in  the  lungs,  the  face 
was  dusky  and  oedematous,  the  skin  covered  with  a  clammy  moisture; 
restlessness  was  extreme,  and  cerebral  symptoms,  such  as  sopor,  delirium, 
and  even  (in  some)  coma,  were  present;  these  patients  were  ordered  small 
but  frequent  doses,  -fa  gr.  every  half-hour  for  four  doses,  afterward  every 
one  to  three  hours,  according  to  the  amount  of  cough  or  oppression:  of 
the  nine  cases,  four  vomited  within  two  hours  of  the  first  dose,  and  all 
showed  signs  of  exhaustion  under  the  medicine,  but  all  of  them  made 
good  recoveries. 

Pneumonia. — The  proper  treatment  of  this  disease  has  long  been  a 
crucial  question,  and  opinions  have  varied  as  to  the  amount  of  influence 
possessed  over  it  by  antimony.  Very  much  depends  upon  the  time  and 
mode  of  administration.  Rasori,  with  his  "  contra-stimulant "  method, 
aimed  at  exciting,  in  or  near  the  inflamed  part,  an  artificial  irritation, 
more  powerful  than  the  original  disease,  and  gave  from  the  commence- 
ment large  doses,  which  he  rapidly  made  enormous.  Thus,  one  adult  was 
ordered  on  the  first  day  about  24  gr.,  and  by  the  eighth,  144  gr.  per 
diem;  the  amount  was  then  reduced  up  to  the  twelfth  day,  when  death 
occurred:  the  same  patient  was  bled  several  times  in  the  course  of  the 
attack,  this  being  considered  to  favor  the  special  action  of  the  drug; 
there  was  no  evidence  of  its  irritant  effect,  but  such  a  mode  of  treatment 


292  MATEEIA   MEDICA    AND    THERAPEUTICS. 

could  not  be  sanctioned  at  the  present  time;  and  although  the  mortality 
in  the  practice  of  the  Italian  physician  was  less  than  that  of  his  contem- 
poraries, it  was  yet  very  large,  and  must  not  be  taken  as  illustrating  the 
results  of  a  judicious  use  of  antimony. 

Laennec  usually  recommended  1  gr.  every  two  hours  till  6  gr.  had 
been  taken,  and  then  an  intermission  for  the  same  period;  sometimes, 
however,  he  increased  the  dose  gradually  to  30  gr.  in  the  twenty-four 
hours.  His  mortality  was  about  one  in  twenty,  reckoning  only  well- 
marked  cases;  that  of  Louis,  following  a  very  similar  method,  was  about 
three  in  twenty.  Trousseau  and  Grisolle,  who  have  treated  the  subject 
fully,  agree  in  speaking  highly  of  this  antimonial  treatment,  the  former, 
indeed,  so  highly,  that  he  foresees  "a  future  generation  will  tax  him  with 
exaggeration."  The  latter  observer  has  specially  analyzed  forty-four 
cases,  showing  some  strikingly  good  results  as  to  relief  of  signs  and 
symptoms  and  as  to  brief  duration,  but  these  reports  must  be  read  in  the 
light  of  our  later  knowledge  of  the  natural  history  of  pneumonia,  which 
would  explain  some  of  the  rapid  recoveries  by  the  occurrence  of  a  natural 
crisis:  vomiting  and  purging  were  often  caused  to  a  serious  extent  (cf. 
Sturges:  "  On  Pneumonia,"  Appendix  G,  "  Treatment  Statistics  "). 

Dr.  W.  Stokes  was  one  of  the  earliest  British  physicians  to  report 
favorably  of  this  remedy  in  pneumonia;  he  stated  that  it  acted  better 
when  given  before  hepatization  had  commenced  than  afterward.  Sir 
Thos.  Watson  also  commends  it,  specially  in  the  stage  of  engorgement, 
and  Dr.  Walshe  lays  stress  upon  its  value  when  it  is  not  given  to  emesis. 
Dr.  C.  J.  B.  Williams  uses  ^  to  -|-gr.  doses  every  two,  three,  or  four  hours 
during  the  early  stages,  combining  them  with  citrate  or  nitrate  of  potash 
(Lectures,  Medical  Times,  i.,  1872). 

Three  grains  is  the  minimum,  and  16  the  maximum  daily  dose  recom- 
mended by  the  German  Codex,  and  these  quantities  nearly  accord  with 
those  already  mentioned:  with  them  vomiting  has  generally  been  observed 
at  first,  and  is  said  to  have  proved  useful  rather  than  otherwise,  and,  later 
on,  tolerance  has  become  established  so  that  irritant  effects  have  not  been 
marked;  nevertheless,  smaller  doses  are  to  be  preferred.  I  have  found 
the  best  results  from  those  ranging  between  -fa  and  ^  gr.  given  every  two 
to  three  hours,  beginning  with  the  smaller  amount  and  increasing  gradually 
so  as  to  produce  general  effects  without  vomiting  or  even  nausea.  In 
severe  cases,  with  high  temperature,  small  frequent  doses  of  aconite  are 
valuable  in  combination  or  alternation  with  antimony  (v.  Vegetable  King- 
dom), and  I  believe  by  this  treatment  may  be  effected  all  the  good  Rasori 
expected  from  preliminary  bleedings.  In  moderately  severe  attacks,  with 
less  pyrexia,  antimony  alone  is  a  good  and  sufficient  treatment  from  the 
first,  although  its  special  value  is  shown  best  when  "  resolution"  begins; 
it  assists  the  clearing  up  of  consolidated  lung.  Another  indication  for 
the  remedy  is  to  be  found  in  the  presence  of  various  complications,  such 


ANTIMONY.  293 

as  bronchitis,  or  whooping-cough,  or  when  the  malady  deviates  from  an 
ordinary  course,  or  occurs  after  influenza  or  in  emphysematous  subjects; 
then  I  have  reason  to  express  the  greatest  confidence  in  it.  It  is  true 
that  Nothnagel,  Nobiling,  and  others,  hold  a  different  opinion,  but  this 
may  be  attributed  partly  to  giving  larger  doses  than  the  patients  could 
bear,  partly  to  the  indiscriminate  use  of  the  medicine  in  all  stages  and 
phases  of  the  disease;  for  Nobiling  speaks  of  emetic  doses  which  induced 
cardiac  collapse,  and  of  small  doses  being  continued  till  intestinal  ulcera- 
tion  occurred,  results  of  which  I  have  never  seen  any  indication  under  the 
method  above  recommended.  I  must,  however,  guard  myself  from  seem- 
ing to  imply  that  it  is  the  only  or  the  best  treatment  for  every  individual 
case:  in  exhausted  broken-down  subjects  the  appropriate  time  for  it  is 
but  short,  and  ammonia,  bark,  phosphorus,  and  alcohol  must  soon  replace 
it,  while  in  septic  forms  of  the  disorder,  which  indeed  are  not  infrequent, 
tinct.  ferri-perchloridi  is  rather  indicated. 

In  the  serious  lobar pneumonia,  as  it  commonly  affects  young  children, 
many  authors — Stille,  for  instance — question  the  propriety  of  giving  an- 
timony in  any  dose,  because  of  the  risk  of  sudden  depressing  effects;  this 
must  be  borne  in  mind,  but  yet  I  have  myself  seen  the  remedy  so  efficient 
that  I  advise  its  employment  very  much  as  in  the  lobular  form  connected 
with  capillary  bronchitis. 

Dr.  George  Buchanan,  while  hesitating  to  recommend  antimony  as  a 
usual  treatment,  records  that  he  has  seen  more  benefit  from  emetic  doses 
of  it  given  at  an  early  period  Q-  to  £  gr.  every  quarter-hour  till  vomiting 
occurred),  than  from  any  single  remedy;  it  seemed  to  control  the  severe 
symptoms,  and  secure  a  favorable  after-progress  (Lancet,  i.,  1868);  this 
is,  of  course,  one  mode  of  using  the  drug,  but  I  prefer  minute  continued 
doses. 

In  cases  of  phthisis  with  intercurrent  acute  pneumonic  attacks,  the 
remedy  is  often  as  useful  as  in  the  idiopathic  malady,  but  special  care 
must  be  taken  to  avoid  emetic  or  irritant  effects,  because  of  the  possibly 
tuberculous  condition  of  the  intestine.  In  "  incipient  phthisis,"  during 
the  stage  of  cachexia  with  febrile  reaction,  small  doses  lessen  irritation 
and  congestion;  and  even,  in  the  developed  malady,  when  there  is  general 
pyrexia,  and  constant  irritative  cough,  it  often  relieves,  rendering  the 
cough  "softer"  and  expectoration  easier. 

Inflammatory  or  True  (Membranous]  Croup. — In  this  serious  disease 
antimony  often  proves  useful,  especially  in  the  early  stages.  It  first  ob- 
tained its  reputation  at  a  time  when  spasmodic  and  catarrhal  croup  were 
not  well  distinguished  from  the  more  serious  malady,  and  when  recovery 
from  those  varieties  was  reckoned  as  recovery  from  true  croup;  but  at 
present,  on  account  of  its  depressing  effects,  most  physicians  limit  its  use 
to  a  few  emetic  doses  in  cases  with  very  severe  spasm,  and  evident  ob- 
struction from  false  membrane  (Klemm:  Schmidt's  Jahrb.,  Bd.  clx.,  s.  45). 


294  MATERIA    MEDICA    AND    THERAPEUTICS. 

Dr.  Elliotson,  however,  records  cases  occurring  in  infants,  and  treated 
successfully  with  £  and  even  £-gr.  doses  every  four  hours — in  one  case  27 
gr.,  and  in  another  33  gr.  being  taken:  vomiting  occurred,  and  some  te- 
tanic spasm,  but  good  recovery  was  made  from  critical  conditions.  Mr. 
Meek  and  others  report  in  the  same  journal  cases  where  ^-gr.  and  even  1 
gr.  doses  were  given  with  favorable  results  to  children  of  four  and  seven 
years;  but,  on  the  other  hand,  Mr.  Kesteven  and  others  record  injurious 
effects  (Medical  Times,  ii.,  1856).  Professor  Bouchut  advocates  giving 
^  to  ^  gr.  frequently,  until  emesis  and  diarrhoea  are  produced,  and  he  re- 
cords several  cases  of  recovery  in  the  second  and  third  stages  (Journal 
filr  Jfinderkn.,  May  and  June,  1861,  ^Lancet,  ii.,  1872). 

I  cannot  adopt  the  above  doses  as  quite  safe,  and  think  that  great 
caution  should  be  exercised  as  to  their  use.  I  recommend  rather  a  solu- 
tion to  be  made  with  1  gr.  in  4  oz.  of  water,  and  of  this  one  teaspoonful 
(^V  gr-)  may  De  given  every  half-hour  for  four  or  five  doses;  it  will  often 
suffice  to  excite  vomiting,  which,  however,  is  not  desirable  unless  there 
be  evident  obstruction  in  the  trachea;  so  soon  as  this  obstruction  is  less- 
ened, the  remedy  should  only  be  given  at  intervals  of  two  to  three  hours; 
the  dyspnoea  is  commonly  removed  for  a  time  after  vomiting,  but  if  it  re- 
cur, the  same  effect  should  be  induced  again:  of  course,  the  patient's 
strength  is  to  be  supported  by  suitable  nourishment,  and  fomentations, 
sprays,  or  other  adjuvants  may  be  used.  With  this  plan  of  treatment  I 
have  many  times  noticed  an  early  abatement  of  the  cough,  dyspnoea,  and 
hoarseness,  lowering  of  the  pulse-rate,  return  of  natural  warmth  and 
color,  and  quiet  sleep.  It  is  true  that  the  sulphate  of  copper  is  often 
preferred  as  an  emetic,  but  under  the  sole  use  of  antimony,  as  described, 
I  have  seen  very  severe  and  advanced  cases  relieved,  and  if  the  dose 
mentioned  be  found  really  too  small  in  a  given  instance,  it  may  be  cau- 
tiously increased. 

Nephritis. — In  acute  nephritis,  whether  induced  by  cold  or  by  fever, 
antimony  has  been  specially  commended  by  Dr.  Bence  Jones,  Dr.  Barlow, 
and  others  ( Guy's  Reports,  vol.  x.).  It  would  certainly  seem,  d  priori, 
that  the  action  of  small  doses  on  the  skin  and  the  intestinal  tract,  as  well 
as  on  the  inflamed  organ,  should  be  of  favorable  character,  but  practically 
I  have  seldom  found  it  to  be  so.  Tartar  emetic  does  not  appear  to  exert 
any  direct  special  power  in  controlling  disease  of  the  genito-urinary  muc- 
ous membrane. 

Spasmodic  Croup  —  Laryngisrmis  Stridulus.  —  Antimonial  emetics 
have  been  very  strongly  recommended  to  arrest  the  paroxysms  of  this 
malady  (Stille),  but  yet,  remembering  its  clear  connection  with  rachitis 
and  impaired  nutrition,  tartar  emetic  is  not  the  remedy  we  should  choose 
for  curing  its  essential  cause:  bromides,  belladonna,  and  cold  bathing, 
•with  tonics  and  nutrients,  are  more  indicated. 

Muscular  Spasm — Rigidity  of  Os   Uteri — Colic, — Muscular  spasm, 


ANTIMONY.  295 

such  as  occurs  in  dislocations,  hernise,  etc.,  may  certainly  be  relieved  by 
emetic  or  nauseant  doses  of  antimony,  and  these  were,  at  one  time,  com- 
monly employed. 

In  difficult  labor  connected  with  rigidity  of  the  muscular  structure  of 
the  cervix  uteri  and  perineum,  relief  may  also  be  given  by  the  same  means. 
Dr.  Kennedy,  of  Dublin,  strongly  recommended  this  treatment,  and  Dr. 
Gilmour  (Liverpool)  quoted  a  large  experience  in  its  favor;  he  claimed 
for  it  also,  not  only  an  immediate  favorable  effect,  but  a  good  influence 
on  the  after-progress  of  the  case,  finding  marked  freedom  from  subse- 
quent inflammations,  etc.,  where  it  had  been  used  (Lancet,  ii.,  1852): 
practically,  however,  chloroform  has  superseded  it. 

For  -Intestinal  Colic,  tartar  emetic  has  sometimes  been  given  success- 
fully by  enema.  In  a  case  dependent  upon  obstruction,  3  gr.  dissolved 
in  8  oz.  of  water  were  injected  per  rectum,  and,  after  some  hours,  the 
obstruction  yielded  and  the  colic  subsided,  without  additional  nausea  or 
prostration  (Lancet,  i.,  1856,  p.  96). 

Constipation. — In  obstinate  cases  connected,  in  part  at  least,  with 
deficient  intestinal  secretion,  and  occurring  especially  in  old  people,  small 
doses  of  tartar  emetic  will  assist  the  action  of  saline  purgatives  such  as 
sulphate  of  magnesia.  Dr.  Nevins  has  recorded  a  good  illustration  of 
this,  and  finds  that  less  than  £-gr.  doses  will  usually  suffice  (<;  Comment., 
Lond.  Pharm."). 

It  has  been  maintained  by  some  distinguished  writers  (Gubler,  Chomel, 
Rayer,  etc.),  that  not  only  the  above-described  but  all  other  therapeutical 
effects  of  antimony  are  dependent  upon,  or  connected  with,  its  emetic, 
or  at  least  its  nauseant  action,  and  are  explained  either  by  an  elimination 
of  morbid  material,  or  by  the  profound  disturbance  and  subsequent  reac- 
tion induced  in  the  economy;  but — not  to  speak  of  the  older  cases  in 
which  benefit  was  conferred  during  "tolerance,"  i.e.,  when  there  was  lit- 
tle or  no  vomiting — I  am  satisfied  that  most  maladies  are  better  treated 
by  small  and  frequent  doses,  which  do  not  cause  vomiting,  and  that  only 
a  few  cases  require  the  production  of  nausea. 

Mania — Melancholia. — There  can  be  no  doubt  that  the  large  doses — 
12  to  30  gr. — formerly  given  to  patients  with  mental  disease,  and  es- 
pecially to  those  suffering  from  acute  or  violent  mania,  served  the  pur- 
pose of  quieting  their  violence  for  a  time,  but  the  general  results  were 
rather  injurious  (Greisinger),  and  professional  opinion  is  justly  opposed 
to  producing  temporary  quiet  by  this  means  (Bucknill).  A  smaller  quan- 
tity, however — £  to  1  gr.,  thrice  daily— I  have  often  known  to  be  well 
tolerated  by  men  who  are  in  fair  bodily  health,  and  it  certainly  acts  better 
when  nausea  and  depression  are  not  induced.  The  same  observation  has 
been  made  by  Schroeder  van  der  Kolk,  a  deservedly  high  authority:  he 
has  seen  marked  benefit  from  the  remedy,  and  recommends  it  in  pill  after 
meals  (to  avoid  vomiting),  the  dose  to  be  cautiously  increased  from  ±  gr. 


296 

In  Puerperal  Mania  the  last-named  physician  has  also  found  small 
repeated  doses  very  useful,  and  Dr.  E.  Kennedy  recommends  them  es- 
pecially for  phlegmatic  patients  (American  Journal,  v.  17).  Dr.  Madden 
has  seen  doses  of  ^  gr.  every  four  hours  act  very  favorably,  subduing 
delirium  in  a  comparatively  short  time;  sometimes  he  has  used  doses  of  1 
gr.,  which  quieted  excitement  still  more  quickly,  but  were  liable  to  de- 
press the  heart-action  unduly  ( Medico-  Chiruryical  Review,  ii.,  1871). 

Puerperal  Convulsion. — For  convulsions  occurring  in  vigorous,  mus- 
cular subjects,  with  high  arterial  tension,  it  is  possible  that  antimony  may 
be  sometimes  indicated.  It  has  been,  with  advantage,  combined  with 
bromide  of  potassium  (Practitioner,  ii.,  18G9).  Before  the  latter  drug 
came  into  use,  I  often  had  recourse  to  antimony,  and  in  cases  connected 
with  renal  disorder  I  observed  relief,  mainly  owing,  as  it  seemed,  to  in- 
creased activity  of  the  skin  and  intestinal  glands. 

Hypochondriasis — Mental  Depression. — In  these  conditions  antimony 
has  been  commended,  but  can  only  act  favorably  through  the  strongly 
stimulating  effect  of  emetic  doses,  and  modern  practice  seldom  resorts  to 
this  treatment. 

Epilepsy. — Like  so  many  other  medicines,  antimony  has  been  applied 
in  the  treatment  of  epilepsy,  especially,  but  not  only,  in  plethoric  subjects 
(Cheyne,  Bell,  etc.,  Glasgow  Medical  Journal,  October,  1857,  Ranking, 
1858). 

Delirium  Tremens. — Though  antimony  is  seldom  now  prescribed  for 
this  condition,  the  good  results  obtained  from  it,  by  Dr.  Peddie  especial- 
ly, require  some  notice.  He  speaks  of  uniform  success  in  upward  of 
eighty  cases,  treated  mainly  by  £  to  £-gr.  doses,  given  every  two  hours 
until  improvement  set  in;  emetic  action  was  not  marked,  but  occurred  to 
some  extent  with  the  early  doses:  secretion  from  the  kidneys  and  the 
skin  was  increased,  but  he  attributed  the  benefit  rather  to  a  sedative  effect 
on  the  nervous  system  and  the  lowering  of  vascular  excitement  (Edin- 
burgh Monthly  Journal,  1854).  In  America  and  in  Germany,  larger  doses 
have  been  successfully  used — Schroff,  for  instance,  giving  4  to  G  gr.  daily, 
and  others  the  same  dose  every  hour.  The  practice,  however,  is  danger- 
ous, because  in  this  malady  the  circulation  fails  so  readily,  and  Dr.  Anstie 
has  pointed  out  that  antimonial  treatment,  though  certainly  successful  in 
some  cases,  has  ended  unfortunately  in  others  ("  Reynolds'  System,"  ii., 
p.  92).  I  have  found  its  moderate  use  valuable  in  young  robust  men,  es- 
pecially in  the  first  attack,  and  even  when  much  gastric  derangement  was 
present:  it  is  not  so  suitable  for  old  or  debauched  subjects. 

Chorea. — The  emetic  action  of  antimony  has  been  utilized  for  the  re- 
lief of  chorea,  and  the  influence  of  the  remedy  has  been  explained  as  re- 
flected through  the  vagus  nerve  to  its  central  origin  in  the  medulla, 
inducing  sedative  effects  in  that  part  (Ringer).  Boulay  and  others  have 
recorded  successful  cases  from  the  use  of  nauseating  doses  (Bulletin  de 


ANTIMONY.  297 

Therapeutique,  v.,  52-4,  London  Medical  Review,  1861),  and  Dr.  West 
recommended  it,  but  I  cannot  consider  it  a  desirable  treatment,  nor  is  the 
evidence  in  its  favor  very  strong.  Comparing  it  with  arsenical  treatment 
in  twelve  cases  in  Parisian  hospitals,  only  half  the  number  were  reported 
cured  by  antimony,  and  some  of  these  lasted  long  enough  at  least  for 
natural  recovery  (fifty-eight  days) ;  whereas  of  eleven  cases  treated  by 
arsenic  all  got  well  (M.  Long).  Of  course,  in  comparisons  of  this  kind 
we  must  make  some  allowance  for  the  tendency  of  chorea  to  recover  under 
judicious  management,  independently  of  medicine,  but  the  general  evi- 
dence in  favor  of  arsenic  much  outweighs  that  in  favor  of  antimony. 

Asthma. — Some  forms,  especially  of  dry  spasmodic  asthma,  are  much 
relieved  by  repeated  small  doses.  Dr.  Ringer  has  noted  their  value  in 
attacks  of  wheezing  and  orthopncea  of  asthmatic  character  to  whnh  some 
children  are  subject  after  exposure  to  cold,  and  which  sometime,  follow 
measles.  In  such  cases  he  recommends  one  teaspoonful  every  quarter- 
hour  of  a  solution  containing  only  1  gr.  in  %  pint  of  water:  even  this 
amount  may  cause  vomiting,  though  that  effect  is  not  necessary  for  relief. 
Dr.  Koch  has  remarked  that  the  remedy  is  most  useful  when  the  attacks 
are  brought  on  by  peripheral  irritation  (cold,  etc.),  rather  than  by  emo- 
tional causes;  and  he  speaks  highly  of  a  combination  with  arsenic  acid — 
the  arseniate  of  antimony — which  he  administers  in  the  form  of  vapor 
from  a  cigarette  (Practitioner,  vol.  iv.). 

^Emphysema. — Dr,  Koch  has  found  the  same  salt  act  well  as  a  nervine 
and  muscular  tonic  in  emphysema;  and,  according  to  my  experience,  it 
certainly  deserves  further  trial. 

COJSTRA-INDICATIOXS. — General  feebleness,  and  especially  feebleness 
of  the  circulation  or  of  the  digestion,  would  usually  prevent  the  giving  of 
antimony;  hence  it  should  rarely  be  prescribed  in  infancy  or  in  advanced 
life.  To  children  it  has  proved  specially  dangerous  sometimes,  by  induc- 
ing a  condition  of  collapse  without  much  warning,  but  a  remedy  so  valuable 
in  their  acute  inflammatory  affections,  should  not  be  wholly  withheld:  in 
old  persons  it  is  more  liable  to  derange  the  stomach.  Before  emetic  doses 
are  ordered  for  a  patient,  inquiry  should  be  made,  if  possible,  as  to  the 
existence  of  hernia,  aneurism,  or  other  arterial  or  cardiac  disease,  cerebral 
congestion,  uterine  displacements,  or  pregnancy:  such  conditions  should 
centra-indicate  the  production  of  vomiting. 

PREPARATIONS  AND  DOSE. — Antimonium  sulphuratum:  dose,  1  to  5 
gr.  as  an  alterative;  10  to  20  gr.  as  an  emetic.  Is  seldom  prescribed  unless 
in  the  compound  calomel  pill  (Plumtner's).  Antimonium  tartaratum  : 
often  given  dissolved  in  plain  water,  but  the  pharmacopceial  solution  of 
it  is  a  "vinum  antimoniale"  containing  2  gr.  to  the  ounce.  This  is  con- 
venient for  giving  small  doses  of  the  drug,  especially  in  febrile  conditions, 
but  is  not  very  suitable  when  larger  quantities  for  depressant  effects  are 
required.  Dose:  as  diaphoretic  and  expectorant,  -fa  to  \  gr.  of  the  powder, 


298  MATERIA    MEDICA    AND    THERAPEUTICS. 

or  15  to  40  min.  of  the  wine  every  one  to  three  hours;  for  children,  smaller 
doses  (y.  pp.  291-4) ;  as  vascular  depressant  or  sedative,  ^  to  1  gr. ;  as  an 
emetic,  1  to  2  gr.  and  upwards.  Uhguentum  antimonii  tartarati  (con- 
tains 1  part  of  tartarated  antimony  to  4  of  simple  ointment).  Antimonii 
oxidum:  dose,  1  to  4  gr.  Pulvis  antimonialis,  the  officinal  substitute  for 
James's  powder:  dose,  3  to  10  gr. — the  latter  dose  causes  vomiting. 
Liquor  antimonii  chloridi :  used  only  as  a  caustic.  Antimonium  nigrum  : 
not  used  except  in  the  preparation  of  antimonium  sulphuratum,  and  liquor 
antimonii  chloridi. 

[PREPARATIONS,  U.  S.  P.  —  Antimonii  et  potassii  tartras  —  tartar 
emetic.  Emplastrum  antimonii:  tartrate  of  antimony  and  potassium 
1  troyounce,  Burgundy  pitch  4  troyounces.  Uhguentum  antimonii :  tar- 
trate of  antimony  and  potassium  100  grains,  lard  400  grains.  Vinum 
antimonii:  tartrate  of  antimony  and  potassium  32  grains,  boiling  dis- 
tilled water  1  fluidounce,  sherry  wine,  sufficient  to  make  1  pint.  Anti- 
monii oxidum  •  Antimonii  oxy sulphur etum :  dose  1  to  3  grains.  Anti- 
monii sulphuretum,  used  in  preparations  Antimonium  sulphuratum. 
Pilules  antimonii  composites :  sulphurated  antimony,  mild  chloride  of 
mercury,  each  12  grains;  guaiac.,  molasses,  each  24  grains.  Divide  into 
24  pills:  dose  1  to  3  pills.] 

ADULTERATIONS. — The  powdered  tartar  emetic  may  contain  free  tar- 
trate of  potash,  lime,  copper,  iron  or  arsenic. 


END    OF    VOLUME    I. 


DATE  DUE 


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1882 

v.l 
Johnson,  Laurence. 

Materia  medica  and  therapeutics 


MEDICAL  SCIENCES  LIBRARY 

UNIVERSITY  OF  CALIFORNIA,  IRVINE 
IRVINE,  CALIFORNIA  92664 


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